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COVAX gets boon from multi-billion dollar commitment – but India’s absence leaves a hole

Caption: A dose of Covishield, provided to Ghana through the COVAX COVAX Advance Market Commitment. Image credit: USAID in Africa, Public domain, via Wikimedia Commons
A dose of Covishield, provided to Ghana through the COVAX COVAX Advance Market Commitment. Image credit: USAID in Africa, Public domain, via Wikimedia Commons

The COVAX facility designed to ensure equitable access to COVID-19 vaccines received a boost earlier this week to the tune of US$2.4 billion, following a summit where countries and private donors made the mammoth commitment. Nonetheless, the facility still reels from India’s step back understandable though it may be.

COVAX is jointly led by the Coalition for Epidemic Preparedness Innovation (CEPI), Gavi, and the World Health Organization (WHO). The facility bills itself as “a global risk-sharing mechanism for pooled procurement and equitable distribution of COVID-19 vaccines.”

The importance of ensuring equitable access to vaccines worldwide cannot be understated. However, there is increasing pressure to expand access with fears that low- and middle-income countries are being left behind. Just recently, the president of the World Bank Group David Malpass and the managing director of the International Monetary Fund Kristalina Georgieva issued a joint statement to the G7 summit. In the statement, Malpass and Georgieva said “The coronavirus pandemic will not end until everyone has access to vaccines, including people in developing countries. 

“Worldwide access to vaccines offers the best hope for stopping the coronavirus pandemic, saving lives, and securing a broad-based economic recovery…we are urging developing countries to move quickly to put in place vaccine procurement and distribution plans and communication efforts to convey the life-saving importance of approved COVID-19 vaccinations. The World Bank and the IMF, working closely with WHO, UNICEF, Gavi, and vaccine manufacturers, are supporting countries in the development and financing of such plans. 

“We call on governments, pharmaceutical companies, and organisations involved in vaccine procurement and delivery to help increase transparency and build greater public information regarding vaccine contracts, options and agreements; vaccine financing and delivery agreements; and doses delivered and future delivery plans.” 

The WHO is one of the co-leaders of COVAX and has expressed concerns over lack of vaccine equity – but chief scientist Dr Soumya Swaminathan has expressed concerns over India’s curbing of vaccine exports. Image credit: Chalermphon Kumchai / 123rf

The commitment on Wednesday of US$2.4 billion is undoubtedly a shot in the arm in efforts to expand vaccine access. It will enable the COVAX facility to procure and subsidise 1.8 billion vaccine doses for those in developing nations in 2021 and early 2022. Gavi, whose chairman Jose Manuel Barroso described the commitment as “a big step towards ‘one world protected’”, estimates that thirty percent of populations countries covered by COVAX will be able to be covered thanks to the funding boost, which takes the total raised for COVAX to US$9.6 billion. 

India has long been thought to assume a central role in the global vaccine rollout, being home to the world’s largest vaccine manufacturer the Serum Institute of India (SII). However, internal catastrophe due to a brutal second wave has led to exports of vaccines being curbed to address the crisis there. 

This has led to concerns. Dr Soumya Swaminathan, chief scientist at the WHO, said that the curb on vaccine exports from India has affected 91 countries. The export ban has meant that the Covishield vaccine, which the SII produces in India, has left manufacturer AstraZeneca in a position where it “has not been able to compensate for the doses which have not come from the [SII].” Of concern is B.1.167, the so-called “Indian variant”, to which countries negatively affected by the export ban are considered to be vulnerable.

“If we continue having this inequitable distribution of available vaccines, we will see some countries going back to some degree of normalcy in their life, while other countries are hit very hard and continue to be hit hard by subsequent waves,” Swaminathan said.

India continues to be embattled by its second wave and must strike a balancing act between its responsibilities at home and abroad. Facing criticism over vaccine procurement, with many states left with shortages impeding inoculation drives, the country appears to be a far cry away from the record-setting momentum it enjoyed in February – not to mention its embrace of vaccine diplomacy. As previously noted by Constantino Xavier of the Centre for Social and Economic Progress, “the vaccine push bolsters India’s credibility as a reliable crisis-responder and solutions provider to these neighboring countries.” 

At that time, Mujib Mashal and Vivian Yee wrote for The New York Times that, whilst “India and China, both of which are making vaccines for the rest of the world, have vast populations of their own that they need to inoculate,” there was scope to export vaccines to other nations. In India’s cases, Mashal and Yee observed “for now, the…government has room to donate abroad, even after months when cases soared and the economy was hobbled, and even as it has vaccinated just a tiny percent of its 1.3 billion people. Part of the reason for a lack of backlash: the Serum Institute is producing at a faster rate than Indias’s [sic] inoculation program can currently handle, leaving extras for donations and exports.”

142157361 - bengaluru / bangalore, india - march 4 2020: a hospital ward for testing covid-19 or coronavirus setup in bangalore, india. the infectious disease has over 93,000 confirmed cases worldwide, with india has reporting 28 confirmed coronavirus cases. COVID-19 case count concept. Image credit: Ajay Bhaskar / 123rf. Critical COVID-19 concept. COVID-19 tests concept.
A hospital ward for testing COVID-19 in Bengaluru. The country is embattled by a vicious second wave and has curbed vaccine exports to focus on its inoculation campaign. Image credit: Ajay Bhaskar / 123rf

The tables have now definitively turned. The freeze on exports is a manifestation of where India is, compared to just a few short months ago. 

A crisis of this magnitude is undoubtedly difficult to manage, but it cannot be denied that missteps have been made. As India continues to languish under the crushing weight of a second wave which is claiming life after life, a resolution to its vaccine woes is needed to benefit not only the country itself, but those who rely upon it. 

COVAX is one means of expanding the global vaccine drive, but it will face a challenge in the SII’s decision to impose a moratorium on exports until the end of the year. Already, there is a shortfall in promised delivery of vaccine doses from the Institute. By the end of May, thirty million had been delivered out of a pledge of more than 111 million. And one cannot entirely blame India. The resurgence of the virus has been more virulent, more traumatic, and more searing than we feared. To go from a country where the “endgame” was in sight to a global hotspot is undeniably presenting multifaceted challenges exacerbated by infrastructural deficiencies, vaccine nationalism, and chronic underfunding of the country’s healthcare system.

Such issues are present worldwide. COVAX is behind schedule In late May, the facility should have delivered 170 million doses. It dispensed just 71 million. Most African countries, according to Swaminathan, have vaccinated just 0.5 percent of their countries. India’s neighbour, Nepal, has vaccinated just 1.9 percent of theirs. Bangladesh has vaccinated just 2.9 percent of theirs. “Of the 1.8 billion vaccines administered globally just 0.4 percent have been administered in low-income countries,” states WHO Director-General Dr Tedros Adhanom Ghebreyesus. “This is ethically, epidemiologically and economically unacceptable.” 

What cannot be denied is that wealthier nations have a role to play. Bill Gates says as much, stating “high-income countries have reserved more vaccines than they need. So without compromising their own domestic vaccination efforts, these countries can be part of the effort to accelerate global vaccine access by sharing the excess doses. I encourage these nations to be bold and commit as soon as possible to sharing over one billion doses in 2021 mostly through GAVI’s COVAX advance market commitment.” The multi-billion dollar commitment made at the summit is a sign that they will step to the plate. But the world still needs India. 

Due to circumstances at least partly beyond anybody’s control, the crisis metastasised to mean that the principle of ‘every man for himself’ became the pragmatic option taken by many, rightly or wrongly. At a time when vaccine doses are in short supply to the tune of almost 140 million – expected to reach 190 million by the end of June – India’s role in the global vaccine supply has never been more clearly demonstrated – and its absence has never been more clearly felt.

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