"COVID-19 has changed the world. It has cost lives, battered health systems and damaged livelihoods. But, through these challenges, we have seen the best of humanity exemplified through strong multilateral cooperation."
Nana Akufo-Addo, President of Ghana
In April 2020, Gavi and COVAX joined the Access to COVID-19 Tools Accelerator (ACT-A) to provide equitable global access to COVID-19 vaccines to tackle the pandemic. In June 2020, the Gavi COVAX Advance Market Commitment (AMC) was launched to finance equitable access in 92 lower-income countries. Since then, US$ 10 billion has been raised for the AMC to procure vaccines and support delivery. Despite a challenging supply situation, COVAX has now shipped one billion doses to 144 countries, including over 870 million to AMC economies.
Using donor funds, committed dose donations and support from multilateral development banks (MDBs), COVAX has secured over 2.8 billion doses for supply by mid-2022. Although COVAX will tailor its support in line with each country’s national strategies and plans, this would allow AMC economies to achieve an average coverage level of around 45% by mid-2022 based on a two-dose vaccine regimen. Supply sourced bilaterally, including by our partner AVATT, the African Union’s African Vaccine Acquisition Task Team, provides countries with further options.
As expected, COVAX has proved to be a crucial source of supply for low-income economies, which have received 80% of their supply from the AMC. Many require urgent support to strengthen their capacity to deliver vaccines. COVAX has provided help to countries to scale up their national vaccination programmes by bundling together procurement financing with catalytic investments to strengthen delivery systems. This will continue to be a focus in the months ahead.
Risks to supply remain in 2022: based upon experience so far, there is significant risk of supply disruption related to export controls, manufacturing scale-up, and delays or failure of vaccine candidates to achieve regulatory approval. More than 100 countries are now recommending booster doses, with an acceleration of these programmes in light of the rapid spread of the Omicron variant. This increases pressure on supply and increases demand from lower-income countries, which are generally seeking to raise coverage to the levels already seen in higher-income countries. If new or adapted vaccines are required to protect against Omicron or other new variants, demand will be intense, and supply limited in the short term.
COVAX requires additional upfront financing of at least US$ 5.2 billion by the end of March 2022 to maximise its capacity to respond to the Omicron crisis and prepare for the next one by acting as a global risk aggregator on behalf of AMC countries – in support of each country’s national plans and coverage targets. That funding would provide the Gavi COVAX AMC with the means to pursue a three-pronged strategy:
to create a Pandemic Vaccine Pool of a minimum of 600 million additional doses at a cost of at least US$ 3.7 billion to increase coverage and mitigate against demand and supply risks;
to fund critical ancillary costs of dose donations (syringes, safety boxes, no-fault compensation insurance, freight) at a cost of US$ 545 million; and
to build on Gavi, the Vaccine Alliance’s comparative advantages strengthening in-country delivery systems to get shots into arms, with at least US$ 1 billion for COVAX (US$ 600 million raised by Gavi, plus US$ 400 million that will be raised concurrently by UNICEF)
In executing this approach in 2022, Gavi would aim to guarantee stable and predictable supply to AMC countries, expanding coverage and starting supply of boosters so that countries can achieve effective immunity. In doing this, the focus would be on the most vulnerable countries, and the 31 low-income economies within the AMC which will require the most support. COVAX’s objective will be to ensure the most marginalised and vulnerable populations get the protection they need.