What is the COVAX Facility and how will it improve access to vaccines for Covid-19?
The European Union recently announced it would not use the World Health Organisation’s COVAX facility to buy vaccines for Covid-19, but what is COVAX and how might it improve our access to a Covid-19 vaccine? Harry Upton, Research Assistant from Keele’s School of Law, explains.
If any of the current candidate vaccines for Covid-19 are successful, global demand will be incredibly high, but supply will be limited. In previous pandemics, such as 2009-H1N1, vaccine procurement was dominated by developed countries who were able to reserve large quantities of vaccine through advance purchase agreements. Developing countries only began to access the vaccine in smaller doses and in the later stages of the pandemic.
The international community has recognised the importance of equitable access to vaccines for Covid-19, with the 73rd World Health Assembly labelling extensive immunisation against Covid-19 as a ‘global public good for health’. Following this, the World Health Organisation (WHO), the Coalition for Epidemic Preparedness Innovations (CEPI) and Gavi announced the formation of the COVAX Facility, to ensure equitable access to vaccines.
What is the COVAX Facility?
The COVAX Facility provides a platform for international cooperation to ensure equitable access to vaccines for Covid-19 in all participating countries and aims to deliver two-billion doses by the end of 2021. By pooling resources, the COVAX Facility is able to invest in multiple vaccine candidates and enter advance purchase agreements to reserve and procure a significant number of doses. These doses will then be shared equally between all participating countries, proportionate to their populations.
How does it work?
How countries will engage with the COVAX Facility depends on their financial power. Wealthy, High Income (HIC) and Upper Middle-Income (UMIC) countries will finance vaccines via their own public finance budgets and will be required to provide an upfront payment and binding commitment to purchase doses by the end of August. Lower-income countries wishing to participate in the scheme will be supported by the Gavi COVAX Advance Market Commitment, a financing mechanism designed specifically to reserve doses of Covid-19 vaccine for developing countries, who would otherwise be priced out of access.
A total of 75 ‘self-financing’ countries have submitted an expression of interest in joining the COVAX Facility, but just 20 out of 90 countries identified as being eligible to receive assistance from the COVAX Advance Market Commitment have done the same. At this stage, these expressions of interest do not translate to a firm commitment to purchase a vaccine through the Facility.
Despite guarantees that participating countries will receive a sufficient number of doses to immunise 20% of their populations, the European Union (EU) has announced that it is not interested in using the COVAX Facility to purchase vaccines for Covid-19. The EU aim to have access to vaccines before the end of 2020, but EU officials believe that reliance on the Facility for access to vaccines will result in higher costs and delays in receiving doses. Instead, they will focus on entering advance purchase agreements to secure vaccines for equitable distribution within EU Member States, rather than in countries across the globe.
The EU’s stance will come as a blow to the COVAX Facility because the pooling mechanism will only be effective if a significant number of countries sign up. Whilst the COVAX Facility is aware that many countries will have completed bilateral purchase agreements already, there is a risk that too many of these deals will undermine the work of the Facility, increasing competition for access to early doses and ultimately harming equitable access in developing countries.
The risk that bilateral agreements concluded by other countries will hinder the work of the COVAX Facility is very real. A finite number of doses will be available in the early stages of production and, if a substantial number of countries have chosen to go it alone, it is possible that they will be given priority over the COVAX Facility, resulting in delays to doses being made available in developing countries. For example, both the UK and CEPI (on behalf of the COVAX Facility) have reached agreements with AstraZeneca to supply doses of their vaccine candidate, if it is successful. However, deliveries to the UK are due to begin in September, whereas the first of the COVAX Facility’s doses are not due to arrive until ‘early 2021’.
The decision of the EU not to participate in the Facility in favour of pursuing bilateral agreements with manufacturers highlights the difficulty of facilitating global equitable access to vaccines for Covid-19. Such decisions undermine the COVAX Facility and are likely to hinder timely access to Covid-19 vaccines in developing countries.
