The COVID-19 Vaccine Global Access (COVAX) is a worldwide initiative working to ensure fair, equitable access to COVID-19 vaccines for every country that participates. COVAX is a collaboration between Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, the Vaccine Alliance, and the World Health Organization (WHO) with UNICEF.
COVAX: Ensuring global equitable access to COVID-19 vaccines
The COVAX solution promises the greatest likelihood of success in achieving this goal as it can provide the largest and most diverse portfolio of COVID-19 vaccine candidates. the Gavi Advance Market Commitment for COVID-19 Vaccines (Gavi Covax AMC) is a binding contract, providing a mechanism to stimulate suppliers to invest products in low-income countries. As such, it supports high-risk populations in low-income countries (LICs) and lower-middle-income countries (LMICs), as part of the new COVAX Facility.
COVAX is one of the four pillars of the Access to COVID-19 Tools (ACT) Accelerator, an initiative begun in April 2020. ACT was formed by the WHO, the French government, the European Commission, and the Bill & Melinda Gates Foundation which aims to bring together governments, businesses, civil society, scientists, philanthropists, and global health organizations.
The ACT Accelerator aims to raise financial support for accelerated research and development, production, and globally equitable access to COVID-19 tests, therapies, and vaccines. The four pillars include:
- Vaccines (COVAX)
- Health Systems
The goals of COVAX
In its inception, COVAX planned to deliver 2 billion doses of COVID-19 vaccine by the end of 2021, particularly in low-to-middle income countries. This represents roughly 20% of the vaccine needs of participating countries.
Over 90 low-income and middle-income countries will be eligible to receive 1 billion doses of the COVID-19 vaccine at low (estimated at 1.60 USD) or no cost through this mechanism. Participating countries include the majority of the G20, including China.
COVAX achievements to date
By the end of August, 330 million doses had been released for delivery, with 230 million being delivered to 142 of the participating economies. According to Gavi the Vaccine Alliance, the key COVAX milestone of two billion doses released for delivery is now expected to be reached in the first quarter of 2022.
A further 1.1 billion doses are expected to become available for delivery between September and the end of 2021. This is the equivalent of approximately 1.4 billion doses available for 2021
In the latest update to this scheme, on the 23rd of September at the global COVID-19 summit, the United States contributed an additional 500 million doses of the COVID-19 vaccine to be delivered through COVAX beginning in 2022. This brings the US total doses to be provided through COVAX to nearly 1.1 billion doses.
Moreover, Sweden has provided an additional 2.1 billion SEK (~243 million USD) on top of the 285 million USD It has pledged to COVAX AMC. Several countries also pledged additional dose donations for countries around the world, including through the COVAX facility. These include commitments from the European Union, as well as Denmark Sweden, and Japan. These are hoped to total 500 million doses by mid-2022.
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COVAX supply forecast: September 2021
Of these 1.4 billion doses, approximately 1.2 billion will be available for AMC participants. Best amounts to 20% of the population cover, or 40% of the adult population in all 92 countries part of the AMC except India.
The supply of COVAX is expected to continue to expand into the first quarter of 2022, reaching it also of 2.6 billion doses available full supply by the end of March. However, according to the forecast, a reduction in the number of doses is expected relative to 2021 for three major reasons:
- A reduction in export, particularly from the Serum Institute of India (SII), which is a key COVAX supplier
- Challenges in scale-up at manufacturing sites that supply COVAX – IN particular supply of the AstraZeneca and Johnson and Johnson (J&J) vaccines
- The timing and probability of application, and regulatory approval for candidates produced by Novavax, SII-Novavax, and Clover, with WHO Emergency Use Listing (EUL) or approval by regulatory authorities required for supply to COVAX participants
The supply forecast is expected to evolve, as it will be regularly updated based on the best information from manufacturers come up with a further analysis by Gavi and UNICEF. The September supply forecast notes that should the export ban from India be lifted, and (J&J) returns to its earlier commitments for 2021 supply, additional doses could become available to COVAX at the end of 2021.
As such, COVAX partners have issued an urgent call to action for the lifting of export restrictions, for manufacturers to deliver on their commitments, and provide transparent updates on queues and delivery schedules.
COVAX partners have also called for countries who have achieved high coverage of a vaccine uptake to give up their place in the queue to COVAX and the LMIC participants it supports. Moreover, to increase volume, shelf-life, and lead times for vaccines, acceleration, expansion, and systemization of dose donations are expected which will allow countries to prepare to receive rollouts.