How the COVAX Facility works for global access to Covid vaccines
The World Health Organization (WHO) has set up the COVAX Facility with the aim of ensuring that countries have rapid access to COVID-19 vaccines, regardless of their purchasing power. COVAX stands for "Covid-19 Vaccines Global Access". The Facility is intended to accelerate the development and production of vaccines. Above all, however, it is responsible for purchasing vaccine doses from manufacturers and allocating them to all countries that have declared their participation in COVAX.
At least two billion quality-assured, on-demand doses of vaccine should be ready by the end of 2021 to end the acute phase of the pandemic, according to COVAX's stated goal. At least 1.3 billion of these vaccine doses are to go to poorer countries so that they can protect at least 20 percent of their population in 2021. The idea behind this is solidarity and the conviction that the Covid 19 pandemic can only be contained in a closely interconnected world if all regions are adequately protected.
Access to vaccination must be possible and affordable for all countries.»
The COVAX Facility is operated by the World Health Organization (WHO) together with the private-public vaccine alliances Gavi (Global Alliance for Vaccines and Immunizations ) and CEPI (Coalition for Epidemic Preparedness Innovations). COVAX now involves 190 countries out of a total of around 200 worldwide, including 98 wealthier countries and 92 low- and middle-income countries.
Wealthier nations pay the full price that the COVAX Facility negotiates with vaccine manufacturers. Poorer countries are asked to contribute financially, but if they cannot, they are entitled to free supplies. In addition, there are countries such as Germany, France or Spain that do not order vaccine via COVAX, but financially support procurement for others.
The European Union is involved with a total contribution of 500 million euros. The EU sees COVAX as complementary to its bilateral agreements with vaccine manufacturers to supply its own population - €2.7 billion is reserved for this purpose. While China has joined the COVAX Facility, the US has so far refused to participate. With President-elect Joe Biden, however, there is hope for a change of course.
Currently, the COVAX Facility has about five billion US dollars. In order to provide the targeted two billion doses of vaccine, a further 6.8 billion US dollars will be needed in 2021. This will include $800 million for research and development, $4.6 billion to provide vaccines to poorer countries, and $1.4 billion for delivery support.
The COVAX Facility has developed different approaches to ensure supply to participating countries:
- Wealthy nations quantify in advance the proportion of the population (between 10 and 50%) to be protected with vaccines from the COVAX programme. COVAX offers two payment models for the corresponding supply. Under the Committed Purchase Agreement, countries pay half of the calculated price for the required doses of vaccine and sign a commitment to purchase the other half (COVAX expects to pay US$6.40 per person for two doses of vaccine). Under the Optional Payment Agreement, countries pay US$6.20 per person upfront to purchase the right to receive 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 are reimbursed, according to the COVAX Facility.
- Wealthier countries can also donate purchased procurement rights anonymously for use in destitute countries. This option is used by Germany and the EU Commission, among others, as well as 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 forDose-Sharingpublished by the COVAX Facility.
- Low- and middle-income countries are supplied with vaccines through the Gavi COVAX Advance Market Commitment (AMC). Thanks to donations from wealthy countries, the programme is now up and running, with a total of USD 2.4 billion available at the end of 2020. Further funding is to be secured, among other things, through bonds. Recipient countries can apply for up to 150 million US dollars to prepare for the upcoming vaccination campaign and receive advice from institutions such as WHO, UNICEF or 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 so far been made by 86 of 92 poorer participating countries.
Vaccine manufacturers working with the COVAX Facility are to be enabled to expand their production capacities quickly and extensively through upfront purchase commitments and advance payments. To this end, the COVAX Facility intends to provide $5.7 billion. The pre-purchase commitments will specify supply volumes, delivery dates and prices, with the COVAX Facility seeking to negotiate prices that are no higher than bilateral supply contracts with individual countries. WHO guidelines will govern how the vaccine supplies are allocated to participating countries and how they are to be used.
to support global initiatives such as COVAX and to make their innovations available worldwide at affordable prices. At the turn of 2020/2021, COVAX has contractually secured access to at least two billion vaccine doses. This is to enable all participating and adequately prepared countries to vaccinate health workers and vulnerable populations in the first half of the year. Most agreements guarantee COVAX a share of the first production batches and further supplies as production progresses. Global allocation is scheduled to begin in the first quarter of 2021.
The targeted two billion vaccine doses relate to agreements between COVAX and the following manufacturers, among others:
- AstraZeneca has committed to supply 170 million doses of the AstraZeneca/Oxford vaccine in a pre-purchase agreement.
- US-based Janssen (or parent company Johnson & Johnson) has entered into a letter of intent to supply 500 million doses of its vaccine.
- The Serum Institute of India, which produces vaccines under licence from several other manufacturers, has agreed to provide between 200 million and 900 million doses of vaccine - from either the AstraZeneca/Oxford candidate or the US manufacturer Novavax's vaccine candidate, depending on the progress of development.
- Sanofi/GSK (France/UK) are on the record with a letter of intent to supply 200 million doses of their joint Sanofi/GSK vaccine.
In addition, COVAX has secured a right of first refusal on more than one billion vaccine doses. The right of first refusal will take effect when vaccines currently being developed with COVAX funds receive regulatory approval.
"The fact that the first vaccines are now available is a ray of hope," Tedros Adhanom Ghebreyesus, WHO director-general, is quoted as saying in a COVAX press release dated Dec. 18: "We will only truly end the pandemic if we end it everywhere at the same time. And we can only do that if we vaccinate some people in all countries, rather than vaccinate all people in some countries."