How is Covax, the program for the fair distribution of vaccines against Covid-19 going

How is Covax

It stands as a "cultural revolution", to guarantee access to vaccines even for countries that cannot afford to buy them. But he has before him several difficulties and critical issues to overcome

(Photo: UNICEF Ethiopia via Flickr CC) Yemen, Costa Rica, Suriname, Nepal, Barbados, Montenegro, Tuvalu, El Salvator, Ecuador, Colombia, Brazil, Eswatini, Nicaragua. And so on, up to exceeding 100, 118 exactly at the time of writing. For a total of over 40 million doses, distributed all over the world. That is what today is, respectively, the counts of countries and vaccines reached and distributed through Covax, the global international program for the fair distribution of vaccines. In recent weeks, announcements have multiplied on the arrival of the first doses in this or that country - Syria among the last to be reached - and exceeding the 100 mark was welcomed as a first important milestone of the program, to support which the foundation of the young activist Greta Thunberg has just joined. It goes on, the countries reached are growing, but the rush to vaccinate the poorest countries must undergo, as and more than elsewhere, an acceleration, it is the appeal that comes from many sides. And without continued support, the program risks not hitting its objectives. And the risk (in terms of health) is for everyone, not just developing countries, the first recipients of the project.

What is Covax

Covax's bet is above all that of a "great cultural revolution", says Andrea Iacomini, Unicef ​​spokesperson for Italy, the operational arm of the project. "The idea behind the program starts from a fundamental premise: there is no safety for anyone if there is no equity, if we do not ensure that low and middle-income countries also have access to vaccination programs of mass. Everyone must be vaccinated, everywhere: everyone's safety depends on fairness, one's own safety depends on global security ". No one is safe, unless everyone is safe, in the words of the World Health Organization.

Covax in fact is this: a program for the development, production, negotiation of vaccine prices and the their distribution, promoted by WHO, Gavi (the global alliance for vaccines), Cepi and WHO and participated by Unicef, in support of 190 countries. But some are more in need than others: in fact, if middle and high-income countries also join the project for which the program can work (by statment) as a sort of insurance for their vaccination programs (not without critical issues, we will see) or as a vaccine procurement system in the absence of bilateral agreements, the focus is on low- and middle-income countries. On the poorest countries: 92 the most needy, to which the program is mainly addressed. Two billion doses of vaccines are intended to be distributed by 2021 (one hundred million insured in the so-called Covax Buffer, for high-risk populations in humanitarian contexts). A “lifeline” for those who do not have access to vaccines, continues Iacomini: “Of these 1.3 billion are destined for the 92 low- and middle-income countries included in Covax. Countries for which this program is in fact the only way to access vaccines, as we are talking about economies that cannot afford to pay for them ".

Who to vaccinate and how

On number of those identified for 2021, Iacomini acknowledges that these are just a few doses and explains how it is a reasoned start to offer a minimum of protection where it is most needed: "We start with the most vulnerable, as people at other risk and health workers ". When the Unicef ​​spokesperson, who has always been involved in the field, talks about starting, he refers not only to the distribution of vaccines but to the entire organization of vaccination plans in the countries where the doses arrive. With a work that actually starts well before: "The work begins by making sure that the different countries are in a position to receive and administer first of all the vaccines, whose arrival is in fact the last act of a complex work begun much earlier : we must work to guarantee a cold chain, the presence of syringes, the management of medical waste, training to manage all this and distribution with agreements with airlines ”. A job that UNICEF is accustomed to, also for the allocation of other vaccines, but far from being taken for granted in a pandemic era.

For all vaccines. “Covax today finds a really complex situation from the point of view of logistics: the pandemic and the closure of the borders have worsened the situations of the poorest countries, from the point of view of hunger, poverty, infant mortality”. To meet the promise to distribute those 1.3 billion anti-Covid-19 vaccines to 92 low- and middle-income countries, more than 500 million dollars are now needed, Iacomini says: "If we lack the funds we cannot do all this".

Covax's difficulties

Lack of funds - Covax is financed by public development aid that comes from the countries participating in the project, or by donations, which can come from philanthropic organizations, as companies, Iacomini reminds us - it is one of the critical issues and challenges raised around the success of the project which, although laudable in its intentions, according to some, risks not achieving the results, or to do it in a way that is not entirely fair as proposed, and too late . "Covax had the ambition to do everything for everyone, also involving high-income countries, and in this way it probably wasted precious time in the negotiations with pharmaceutical companies", explains Silvia Mancini of Doctors Without Borders (MSF ): "And perhaps, rather than acting as an autonomous initiative, it could be thought of as a project to support and strengthen existing realities in the field, such as the African Union".

The perplexities raised by MSF - which recognizes to the initiative the merit of having created a buffer intended for the populations most in crisis, hit by catastrophic events - they may seem only a defect in the form of the Covax structure, but what Mancini refers to is also a problem of functioning: "Creating structures autonomous, rather than aiming to complement the existing ones, risks segmenting the negotiation capacity, but not only: having wanted to include high-income countries and poor countries in the same program I risk creating unequal treatments, because the former also have the opportunity to proceed alone, while for the latter Covax is the only solution ". But not only: Mancini refers to a clause provided by the program that allows self-financing countries (those that supported the initiative) to be able to request doses to vaccinate up to 50% of their population, when the target for the funded countries is 20%. "Self-financing countries may also have the option of choosing vaccines", adds Mancini.

The issue of vaccine availability

Alongside this, some practical aspects remain that can hinder the success of Covax. At the moment, we said, there are about 40 million doses of the vaccine distributed through the program in 100 different countries. Just a drop, if we think, by comparison that only half of them have been distributed in Italy. And the goal of vaccinating at least 20% of the population, although aimed at sheltering the most vulnerable and health workers, is also limited. Covax could also be faced with a problem first of all of availability, and therefore delays, in vaccines. It has already happened in recent weeks, with the case of India which, faced with the worsening of the pandemic, had blocked the export of doses of the AstraZeneca vaccine destined for the Covax program.

“Covax's goal is endangered by chronic under-financing, nationalism and export restrictions ", wrote, summarizing the problems of the initiative Deborah Gleeson, Associate Professor in Public Health at La Trobe University on the pages of The Conversation in recent days, among the others, primarily WHO itself through the voice of its general manager. Gleeson proposed to look even further to try to expand the vaccination offer to countries most in need in the short term, for example the suspension of intellectual property rights for Covid-19 products in the pandemic era as requested by the World Trade Organization (Wto ) from India and South Africa for months. An initiative that also for MSF could help fight inequality and encourage a more equitable distribution of vaccines and medicines. As well as sharing the extra doses of rich countries with those most in need, as requested by Unicef ​​and the WHO.


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