Suzanne Driscoll, M.Ed, MBA 

Hope is in the air as the world eagerly awaits the approval of new COVID-19 vaccines. After nine long months of quarantines, economic fallout, and over 1.45 million deaths,(1) several pharmaceutical companies are expecting approval of their vaccines by the U.S. Food and Drug Administration (FDA) (2) within the next few weeks. Distribution to various locations in the U.S. has already begun, and plans are being formed in each state as to who will receive the vaccine first. However, the concern is that high-income countries will hoard supplies for their own populations causing delays in distribution to poorer countries. 

Latin America has experienced a third of the world’s deaths from the coronavirus, and Africa has now passed two million cases. (3) Quarantines and business shutdowns have hit poor countries especially hard, where people live on the margins even in prosperous times. It is believed that many COVID-19 infections and related deaths in Africa are likely being overlooked (3) as testing rates in the continent are among the lowest in the world, and many deaths of all types go unrecorded. 

Coalitions Lead the Way: 

The COVID-19 Vaccines Global Access (COVAX) Facility (4) was launched by The World Health Organization (WHO) (5), Gavi, (6) and the Coalition for Epidemic Preparedness (CEPI).(7) Their main purpose is to ensure equitable access to COVID-19 vaccines to end the pandemic’s acute phase worldwide by the end of 2021. The goal of their Access to COVID-19 Tools (ACT Accelerator) (8) plan is to accelerate the development, production and distribution of COVID-19 tests, treatments, and vaccines. The plan states that once a vaccine is shown to be safe and effective and authorized for use, “all countries will receive doses in proportion to their population size, albeit initially in reduced quantities. This will enable every country to start by immunizing the highest priority populations.” 

In the second phase, vaccines would continue to be deployed to all countries so that additional populations can be covered according to national priorities. 

Specifically, the allocation of vaccines will occur in the following way: 

1. An initial proportional allocation of doses to countries until all countries reach enough quantities to cover 20% of their population. 
2. A follow-up phase to expand coverage to other populations. If severe supply constraints persist, a weighted allocation approach would be adopted, taking into account a country’s COVID threat and vulnerability. This would be decided based on how fast the virus is spreading and how vulnerable a country’s health system is in regard to the availability of beds in hospitals. 

COVAX is taking the lead to recruit countries to join their effort to buy and fairly distribute COVID-19 vaccines around the globe. In September 2020, they announced that countries representing two-thirds of the world’s population have agreed to the plan. However, the U.S. and China are noticeably absent from the list. 

Critics have argued that countries most in need should get the vaccine first, but it is believed that the proposed allocation method was the best way to get agreement from all parties. The 92 lower-income countries that have joined COVAX will have vaccine doses purchased for them. Wealthier countries will pay for their own supplies. Thus far, only $700 million (9) has been raised to pay for the vaccine in lower-income countries, short of the $2 billion thought needed by the end of the year. 

Whether they support the COVAX plan or not, wealthier countries such as Great Britain, the United States, France, and Germany have already negotiated deals with pharmaceutical companies directly, meaning that the vast majority of the world’s vaccine supply for next year is already reserved. 

Bill Gates Plays an Active Role: 

Retired Microsoft founder Bill Gates helped launch and bankroll Gavi and CEPI and is one of the World Health Organization’s largest donors. His $50 billion Bill & Melinda Gates Foundation (10) is working actively to procure coronavirus vaccines for more than 150 countries. 

For over two decades, Gates and his team have been funding research and distribution for a variety of vaccines such as polio and tuberculosis, and they also work to eradicate malaria and reduce HIV infections. The foundation is able to draw on connections and infrastructure they have built over the years to help guide the effort. 

When many western pharmaceutical companies stopped making other types of vaccines that were unprofitable, Gates stepped in with providing subsidies, advance commitments, and volume guarantees. 

“We know how to work with governments, we know how to work with pharma, we’ve thought about this scenario,” said Gates in a recent interview. (11) “We need—at least in terms of expertise and relationships—to play a very, very key role here.” 

Gates has not had much luck in obtaining funding from the U.S. for the global vaccine effort, as well as for therapeutics and diagnostics. He asked the Trump administration and both parties of Congress for $8 billion, but so far, no commitments have been made. 

Increasing the Supply: 

One proposed solution to increase the supply of vaccines is to compel the vaccine makers, who have benefited greatly from government funding, to share their technology and data with other countries. Several such as South Africa, Kenya, Mozambique, and India are advocating through the World Trade Organization (12) that the enforcement of coronavirus-related intellectual property rights regarding vaccines is suspended. Many pharmaceutical companies are opposed to the idea. 

The COVID-19 vaccine will reach developing countries eventually. The question remains as to how soon they will receive it and how many more people will die waiting for that to happen. 

References: 

1. https://ourworldindata.org/covid-deaths 
2. https://www.fda.gov/emergency-preparedness-and-response/counterterrorism-and-emerging-threats/coronavirus-disease-2019-covid-19 
3. https://www.reuters.com/article/us-health-coronavirus-africa/coronavirus-cases-in-africa-surpass-the-2-million-mark-reuters-tally-idUSKBN27Y2CZ 
4. https://www.who.int/publications/m/item/fair-allocation-mechanism-for-covid-19-vaccines-through-the-covax-facility 
5. https://www.who.int/emergencies/diseases/novel-coronavirus-2019 
6. https://www.gavi.org/covax-facility
7. https://cepi.net/
8. https://www.who.int/initiatives/act-accelerator 
9. https://www.sciencemag.org/news/2020/09/who-unveils-global-plan-fairly-distribute-covid-19-vaccine-challenges-await 
10. https://www.gatesfoundation.org/ 
11. https://www.aspenideas.org/sessions/the-global-vaccine-race-a-conversation-with-bill-gates
12. https://www.wto.org/english/news_e/news20_e/trip_20oct20_e.htm