How the COVAX Facility works for global access to Covid vaccines
With the goal of ensuring that countries have the best possible access to COVID-19 vaccines, regardless of their purchasing power, the World Health Organization (WHO) and partner organizations launched the COVAX initiative and its COVAX Facility in April 2020. COVAX stands for "Covid-19 Vaccines Global Access". The main role of the COVAX Facility is to order vaccine doses from manufacturers and allocate them to all countries that have declared their participation in COVAX. These are in Africa, Asia, Oceania, South America and Europe.
At least two billionquality-assured and needs-based vaccine doses should be ready by the end of 2021 to end the acute phase of the pandemic, according to COVAX's stated goal. Poorer countries are expected to receive at least 1.8 billion of these vaccine doses to protect at least some of their populations by early 2022. Behind this is the idea of solidarity and the conviction that, in a closely interconnected world, the Covid 19 pandemic can only be contained if all regions are adequately protected.
Operated by WHO together with the private-public vaccine alliances Gavi (Global Alliance for Vaccines and Immunizations, lead) and CEPI (Coalition for Epidemic Preparedness Innovations) and also in partnership with UNICEF, the United Nations Children's Fund. As a "vaccine pillar," COVAX and COVAX Facility are part of the umbrella organization Access to COVID-19 tools (ACT). ACT is also responsible for diagnostics, medicines, and health systems strengthening. In their report "ACT now, ACT together" released April 23, ACT initiators take stock of the situation.
One year after the launch of ACT, world leaders face a choice: invest in saving lives by addressing the cause of the pandemic everywhere and now, or continue to spend trillions on the consequences with no end in sight.»
There are now 192 countries participating in COVAX out of a total of about 200 worldwide, including 100 wealthier countries and 92 low- and middle-income countries.
When wealthier nations purchase vaccines through the COVAX Facility, they pay the full price negotiated with vaccine manufacturers. Given the uncertain outcome of vaccine trials, COVAX provides richer countries with an additional safeguard alongside their bilateral contracts with pharmaceutical companies. Poorer countries are asked to contribute financially, but if they are unable to do so, they are entitled to free supplies. Many wealthier countries choose not to be supplied by COVAX. They do, however, financially support procurement for poorer countries or donate purchased quotas. Against this background, COVAX can be described as a purchasing community and an insurance company, but also as an aid community.
A significant portion of the vaccine donations involve resources from bilateral contracts that many wealthy nations have with vaccine manufacturers-in lieu of or in addition to ordering from COVAX.
Financial assistance from many quarters
To help COVAX achieve its goals, quite a few nations and communities of nations pledged well above average millions in support at international summits. At the G7 digital summit on Feb. 19, 2021, for example, the EU announced it would increase its support for the COVAX Facility to 1 billion euros, after initially pledging 500 million euros. Germany announced an additional 980 million euros for COVAX at that summit and added another 100 million euros on May 22, 2021. With a total contribution of more than two billion euros, this makes Germany one of the initiative's biggest supporters.
I thank the United States, Germany, the European Commission, the European Investment Bank, Japan and Canada for their significant funding commitments. Today's news shows us that solidarity wins out.»
While China has been a member of the COVAX Facility since October 2020, the USA did not join until after President Joe Biden took office in January 2021. The USA will support COVAX, as Biden announced at the virtual G7 summit, with an expected total of $4 billion in 2021 and 2022.
To accelerate vaccine delivery to poorer countries, the U.S. and vaccine alliance Gavi launched a global campaign to raise an additional $2 billion on April 15, 2021. At the virtual launch event, numerous governments, as well as international foundations and commercial enterprises, made pledges worth nearly $400 million.
At the subsequent Gavi COVAX AMC "One World Protected" Summit in Japan on June 2, 2021, the campaign raised an additional $2.4 billion from more than 20 donor nations, bringing the total to $9.6 billion. With these funds, the COVAX AMC can secure 1.8 billion fully subsidized doses for delivery to low-income countries in 2021 and early 2022.
Through its "Go Give One" campaign, the WHO Foundation has been calling on helpful people around the world to donate $7 since May 18, 2021. This could finance one more vaccination dose in poorer countries, according to a press release from the foundation. It wants to win 50 million supporters. In Germany, Unicef is appealing to citizens' willingness to donate.
More and more vaccine donations
Appeals for vaccine donations are also bearing fruit. For example, Germany is giving up all vaccine supplies from British manufacturer AstraZeneca to COVAX until further notice, the Federal Ministry of Health (BMG) announced on August 4, 2021. In a first step, 1.3 million doses of the vaccine will be delivered directly to COVAX without a detour via Germany. In addition, according to information from the BMG, Germany will forgo vaccine supplies from Johnson & Johnson in August 2021 for the benefit of other EU member states. The Cabinet had decided in early July to dispense at least 30 million doses of vaccine to developing countries and others by the end of the year. Of these, 80 percent are to be provided to COVAX and 20 percent are to go directly to other countries.
The U.S. announced shortly before the June 11-13 G7 summit in Cornwall, UK, that it would cover the cost of supplying 500 million doses of BioNTech/Pfizer vaccine to COVAX. 200 million of these doses are to be delivered before the end of 2021, with 300 million to be delivered in the first half of 2022. UK also announced on 10/06/2021 to donate 100 million doses of vaccine in 2022 in addition to its previous commitment, 80 million of which will go to COVAX and the rest directly to countries in need.
In the final declaration of the G7 summit the participating countries committed to donate 870 million vaccine doses to COVAX. At least half of these are to be delivered before the end of 2021, with the remainder in 2022. In addition, the seven heads of state and government reaffirmed their support for COVAX. German Chancellor Angela Merkel spoke at the summit of a total of 2.3 billion vaccine doses that G7 countries want to distribute to poorer countries by the end of 2022. In the process, she said, Germany is financing some 350 million doses, primarily through COVAX. International organizations such as the WHO and the United Nations, as well as aid agencies such as AMREF Health Africa, welcomed the announcements but called for larger and faster deliveries. COVAX is currently trying to secure as many doses as possible to overcome growing shortages. In the third quarter of 2021, a particularly large gap looms between expected supplies and what countries could actually vaccinate, according to WHO.
The EU plans to donate at least 100 million vaccine doses to COVAX by the end of 2021 from quotas already ordered. This was announced by Commission President Ursula von der Leyen at the G20 health summit in Rome on May 21, 2021. Germany will take over 30 million doses of this, according to German Chancellor Angela Merkel.
The United Arab Emirates (UAE) announced at the "Global Citizen's Vax Live Concert" benefit concert in London on May 8, 2021, that it will donate 1 million vaccine doses to low-income countries through COVAX. The UAE also pledged to distribute 25 million vaccine doses worldwide through its global supply chain in support of COVAX.
Substantial donation pledges have also come from many other countries, as well as commercial enterprises and foundations, including Croatia, New Zealand, Norway, Sweden and Spain, since the spring of 2021.
An Elaborate Mechanism
Never before in history has there been such a large and complex vaccine rollout as in the COVID-19 pandemic. To ensure fair coverage for all participating countries, the COVAX Facility developed different approaches:
- Well-being nations quantify in advance the proportion of the population (between 10% and 50%) to be protected with vaccines from the COVAX program. COVAX offers two payment models for the appropriate supply. Under the "Committed Purchase Agreement," countries pay half of the calculated price for the required doses of vaccine and sign a purchase commitment for the other half (COVAX calculates $6.40 per person for two doses of vaccine). Under the "Voluntary Purchase Agreement" (Optional Payment Agreement), countries pay US$6.20 per person upfront, purchasing the right to be supplied with the vaccines of their choice from the COVAX range. The vaccines are purchased either directly from the manufacturer or with the help of UNICEF and other intergovernmental organizations. Unused funds will be reimbursed, according to the COVAX Facility.
- Wealthier countries can also anonymously donate purchased procurement rights for use by destitute countries. Among others, Germany and the EU Commission make use of this option, but also non-governmental organizations such as the Gates Foundation. In addition, richer countries can make vaccines that they have secured in bilateral contracts with manufacturers available to poorer countries on fair terms. The procedure is governed by the principles published by the COVAX Facility, "Principles for Dose-Sharing."
- Low- and middle-income countries are supplied with vaccines with the help of the Gavi COVAX Advance Market Commitment (AMC). Thanks to donations from wealthy countries, the program was able to get off the ground; by the end of 2020, a total of USD 2.4 billion had already been made available for this purpose. Further funding is to be secured, among other things, through bonds. Recipient countries can apply for up to $150 million to prepare for the upcoming vaccination campaign, with advice from institutions such as WHO, UNICEF and the World Bank. Before receiving vaccines, countries must demonstrate proper infrastructure, as well as well-trained health workers and community education activities. Detailed vaccine requests have been made so far by 86 of 92 poorer participating countries. A "Country Readiness Portal" allows AMC participants to submit their final national deployment and vaccination plans. To help poorer countries access vaccines more quickly, COVAX developed a new financing mechanism in collaboration with the World Bank. It will make it easier to purchase additional doses beyond donated quotas, according to a press release dated July 26, 2021.
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News from participating countriesBy August 06, 2021, COVAX has delivered more than 188 million doses. Of the 138 countries and regions reached, about three-quarters are among the 92 lower-income countries. They are receiving vaccines funded through the Gavi COVAX Advance Market Commitment (AMC). COVAX expects all countries that have requested vaccines to receive shipments in the first half of 2021.
Here are selected news items, sorted by timeliness:
- Peru, Guatemala, Paraguay, and Nicaragua received their first shipments on August 5 and 6, 2021, out of a total donation by Spain of 22.5 million doses to COVAX.
- On July 30, initial contingents from a five-million-dose donation by Norway to COVAX arrived in Nicaragua and Uganda. On the same day, initial shipments of a Swedish donation totaling three million AstraZeneca vaccine doses reached Kyrgyzstan and Afghanistan.
- In July 2021, Burkina Faso, Djibouti, and Ethiopia received nearly one million doses of vaccine from a total U.S. donation quota of 25 million doses for African Union countries. The doses will be distributed through COVAX.
- In Afghanistan, 1.4 million doses of Johnson & Johnson's vaccine arrived on July 9, 2021, as part of the COVAX program. A second shipment of vaccine donated by the United States will bring the total to 3.3 million doses. To date, less than four percent of the Afghan population has been vaccinated. The shipments are part of U.S. President Joe Biden's pledge to donate 80 million doses of vaccine for global distribution.
- Honduras received the first shipment of vaccine under the COVAX program on June 27, 2021, which was 1.5 million doses of Moderna vaccine donated by the United States.
- The Philippines received its fourth shipment of COVAX on June 10, with nearly 2.3 million doses of the BioNTech/Pfizer vaccine.
- More than 705,000 doses of AstraZeneca vaccine reached Ukraine on June 3,2021.
- New Zealand pledged a donation of 1.6 million doses of vaccine on May 31. These will primarily benefit countries and regions in the Pacific.
- In Kosovo, the second vaccine shipmentarrived via COVAX on May 12. A delegation led by Prime Minister Albin Kurti took delivery of 38,400 doses
- Between March 21 and May 2, 2021, Brazil received an additional 4 million doses of vaccine through COVAX.
- On April 20, Jordan and Fiji each received their second vaccine shipment through the COVAX Facility.
- First doses of vaccine arrived in Guinea-Bissau and Mauritania on April 14, 2021. Libya and Tuvalu received vaccines from the COVAX Facility for the first time on April 9, 2021. Two days earlier, initial shipments reached Barbados and Costa Rica.
- In early March, numerous African countries received vaccine doses for the first time, including Nigeria (3.94 million doses) and the Democratic Republic of Congo (1.7 million doses). In Asia, shipments arrived in Cambodia (324,000 doses) and the Philippines (500,000 doses). In South America, the first COVAX shipment arrived March 1: Colombia received 117,000 doses of the BioNTech/Pfizer vaccine. A European country, Moldova, also received vaccine through COVAX.
- On February 26, 2021, 117,000 doses of BioNTech/Pfizer vaccine reached South Korea, which had funded this shipment itself.
- On February 24, 2021, Ghana became the first country in the world to receive vaccines through the COVAX Facility: 600,000 doses of AstraZeneca/Oxford vaccine, produced under license by the Serum Institute of India.
- North Korea is scheduled to receive 1.7 million doses of AstraZeneca/Oxford vaccine through COVAX by the end of May. The country, which says it has no COVID-19 infections, had asked COVAX to supply it.
- China plans to provide COVAX with ten million vaccine doses from three Chinese manufacturers. According to the Ministry of Foreign Affairs in Beijing, they want to contribute to meet urgent needs in developing countries. Separately from COVAX, China has already supplied vaccines from its own production to 16 African countries
- Bangladesh, with World Bank support, is purchasing vaccines for 20% of its population through the COVAX Facility. Plans are underway to purchase additional doses from COVAX or directly from manufacturers for an additional 11% of the South Asian country's population of more than 160 million.
- South Africa has secured a total of 12 million doses of vaccine through the COVAX Facility. The country's vaccination campaign began in February 2021 - with 80,000 doses of Johnson & Johnson vaccine purchased independently from COVAX.
This is encouraging progress, but the amount of doses distributed via COVAX is still relatively small. One of our main priorities now is to increase the ambition of COVAX to help all countries end the pandemic.»
Collaboration with manufacturersVaccine manufacturers working with the COVAX Facility will be enabled to rapidly and extensively expand their production capacity through upfront purchase commitments and advance payments. The COVAX Facility is providing billions of dollars for this purpose. The pre-purchase commitments will specify supply volumes, delivery dates, and prices, with the COVAX Facility seeking to negotiate prices that are at most on par with bilateral supply contracts with individual countries. How vaccine supplies are allocated to participating countries and are to be used are governed by WHO guidelines.
- AstraZeneca supplied the first vaccines delivered through the COVAX Facility in late February 2021. Together with its licensees, including most notably the Serum Institute of India, the company provided the lion's share of the first 38 million doses of vaccine delivered by COVAX by April 8, 2021. The goal is to supply a total of 142 countries with hundreds of millions of doses of the vaccine in the following months, the British-Swedish company said. The majority of those doses will go to low- and middle-income countries, it said. AstraZeneca was the first global pharmaceutical company to join COVAX in June 2020. The British-Swedish parent company had pledged to provide 170 million of its AZD1222 vaccine.
- Chinese company Clover Biopharmaceuticals agreed to provide up to 414 million doses of its SCB-2019 vaccine candidate to the COVAX Facility in an advance purchase agreement. This is contingent on receiving emergency approval from the WHO. In return, representatives of the COVAX Facility committed to purchase a total of 64 million doses in 2021. The following year, there is an option to purchase up to 350 million additional doses from Clover. Delivery of the vaccine is expected to begin in Q4 2021.
- U.S.-based Johnson & Johnson, through its Belgian subsidiary Janssen Pharmaceutica N.V., has announced the delivery of 220 million doses of its one-dose vaccine to the COVAX Facility. The vaccine is to be made available through South Africa's Aspen Pharmacare by the third quarter of 2021, reportedly at a price of ten U.S. dollars per dose. A further 180 million doses for the 55 member states of the African Union are to follow by the end of 2021. In total, the U.S. company holds out the prospect of supplying around 500 million doses to COVAX by 2022. A share of 200 million doses is to be made available as early as 2021, the company announced at the G20 Health Summit in Rome on May 21,2021.
- Moderna (USA) has pledged to supply up to 500 million vaccine doses to COVAX. Of these, nearly 100 million are scheduled to arrive in 2021, the company announced at the G20 Health Summit in Rome on May 21, 2021. The remaining volumes are scheduled for 2022.
- The U.S. manufacturer Novavax entered into an advance purchase agreement for 350 million doses of its NVX-CoV2373 vaccine candidate for delivery to COVAX on May 7, 2021. The delivery is part of a commitment for a total of 1.1 billion doses announced by the company on February 18, 2021. Novavax expects to begin delivery of the vaccines produced by the Serum Institute of India in the third quarter of 2021. Development and manufacturing of NVX-CoV2327 are supported by funding from the COVAX Facility.
- The CEO of U.S.-based Pfizer announced at the G20 Health Summit in Rome on May 21, 2021, that his company would provide COVAX with one billion doses of the BioNTech/Pfizer vaccine in 2022. As early as 2021, the company plans to supply one billion doses directly to poorer and very poor countries. Very poor countries will be charged only the cost of manufacturing, Pfizer CEO Albert Bourla said, while somewhat wealthier countries will be charged a low price. On June 10, 2021, Pfizer and BioNTech said the U.S. would cover the cost of 500 million of the doses to be delivered at a charitable price.
- Sanofi/GSK (France/UK) are on the record with a letter of intent to supply 200 doses of their joint vaccine. The company hopes to have its first vaccine candidate approved by the end of 2021.
- The Serum Institute of India, which produces vaccines under license from several other manufacturers, has agreed to supply COVAX with 100 million doses each of the AstraZeneca/Oxford candidate and U.S.-based Novavax's vaccine candidate, at $3 per dose. Negotiations are also underway to supply an additional 300 million to 400 million doses of vaccine. On February 15, 2021 the WHO confirmed the suitability of two versions of the AstraZeneca/Oxford vaccine for emergency use. One version is from the Serum Institute of India, and the other is from AstraZeneca - SK Bio (South Korea). Following the positive evaluation of the quality, safety and efficacy of both vaccine variants by WHO, global deliveries under COVAX could start in the first quarter of 2021. However, deliveries of vaccine doses from the Serum Institute of India will be delayed in March and April 2021 due to a new wave of COVID-19 infections in India, which is greatly increasing the country's own demand for vaccines.
- A pre-purchase agreement has been signed with Chinese manufacturer Sinopharm for the inactivated virus vaccine SCB-2019 with WHO emergency certificate. Approximately 60 million doses are planned to be made available by Sinopharm from July to October 2021. If needed In addition, COVAX may purchase another 60 million doses in the fourth quarter of 2021 and another 50 million doses in the first half of 2022.
- After Sinovac's "CoronaVac" vaccine received WHO emergency approval on June 1, 2021, the Chinese pharmaceutical company held out the prospect of supplying a total of 380 million doses. As stipulated in a pre-purchase agreement, the COVAX Facility will initially purchase 50 million doses, which will be made available from July to September 2021. There is also an option to purchase an additional 150 million cans in the fourth quarter of 2021 and an additional 180 million cans in the first half of 2022.
In addition, COVAX has secured a right of first refusal on additional vaccine doses. It will take effect when vaccines currently in development with COVAX funds receive regulatory approval.