COVAX, vaccine donations and the politics of global vaccine inequity

Abstract

Background In 2021, donor countries, the pharmaceutical industry, and the COVAX initiative promoted vaccine donation or “dose-sharing” as a main solution to the inequitable global distribution of Covid-19 vaccines. COVAX positioned itself as a global vaccine-sharing hub that promised to share doses “equitably, effectively and transparently,” according to rational criteria overseen by independent scientists. This article provides a critical analysis of the principles and practice of “dose-sharing,” showing how it reveals the politics at play within COVAX. Results Donated doses were an important source of COVAX’s vaccine supply in 2021, accounting for 60% of the doses the initiative delivered (543 million out of 910 million). However, donations could not compensate fully for COVAX’s persistent procurement struggles: it delivered less than half of the two billion doses it originally projected for 2021, a fraction of the 9.25 billion doses that were administered globally in 2021. Donor countries and vaccine manufacturers systematically broke COVAX’s principles for maximizing the impact of dose-sharing, delivering doses late, in smaller quantities than promised, and in ad hoc ways that made roll-out in recipient countries difficult. Some donors even earmarked doses for specific recipients, complicating and potentially undermining COVAX’s equitable allocation mechanism. Conclusions COVAX’s pivot from global vaccine procurement mechanism to dose-sharing hub can be seen as a “win-win-win” solution for COVAX itself (who could claim success by having access to more doses), for donor countries (who could rebrand themselves as charitable donors rather than “vaccine hoarders”), and for the pharmaceutical industry (maintaining the status quo on intellectual property rights and protecting their commercial interests). Although dose-sharing helped COVAX’s vaccine delivery, its impact was undermined by donors’ and industry’s pursuit of national security, diplomatic and commercial interests, which COVAX largely accommodated. The lack of transparency and accountability mechanisms within COVAX’s overly complex governance structure as a global public-private partnership enabled these practices.

COVID-19 vaccine wastage in the midst of vaccine inequity: causes, types and practical steps

“…For example, the contracts between vaccine manufacturers and the US Federal government included clauses such as ‘The Government may not use, or authorise the use of, any products or materials provided under this Project Agreement, unless such use occurs in the United States or U.S. territories’. 24 Further, to complement manufacturers’ printed expiry dates, the Vaccine Presentation and Packaging Advisory Group, 25 UNICEF and other LMIC vaccine delivery-focused agencies should accelerate the use of electronic lookup of expiry date for new vaccines where stability has not yet been fully established. Dynamic lookup of expiry date based on batch number avoids the problem of static printed expiry dates, and allows for dynamically adjusting the expiry date when new stability information to extend shelf-life becomes available.…”

“…Furthermore, manufacturers of vaccines should continue to apply for shelf-life extensions and remove any contractual barriers impeding donating to LMIC. For example, the contracts between vaccine manufacturers and the US Federal government included clauses such as ‘The Government may not use, or authorise the use of, any products or materials provided under this Project Agreement, unless such use occurs in the United States or U.S. territories’ 24. Further, to complement manufacturers’ printed expiry dates, the Vaccine Presentation and Packaging Advisory Group,25 UNICEF and other LMIC vaccine delivery-focused agencies should accelerate the use of electronic lookup of expiry date for new vaccines where stability has not yet been fully established.…”

Covid-19—How Europe’s vaccine donations went tragically wrong

“…Covax was pushed to the back of the queue with manufacturers, so donations from rich countries became the mainstay for the global south until the second quarter of 2022. A recent analysis from the University of Oslo estimates that donated doses account for roughly 60% of the doses Covax delivered in 2021 3…”

“No Regrets” Purchasing in a pandemic: making the most of advance purchase agreements

“…Similarly, impacts on overbuying could go either way: essentially such a mechanism would allow buyers to choose their own balance of supply security/diversity versus cost. The resale market should have one advantage over donations, however: it should disincentivize the dumping of soonto-expire or less desired products only when APA holders are absolutely sure they will not need them [51]. One potential challenge to this solution is the reluctance of some suppliers to allow secondary markets: it has been alleged that many COVID-19 vaccine suppliers prohibited resale of products within the terms of their APAs [52].…”