Covax calls for urgent action to close vaccine equity gap

Covax, the global vaccine programme run by Gavi and the World Health Organization (WHO), has called for immediate measures addressing the vaccine inequities between lower and higher-income countries.

Despite unprecedented progress in terms of speed, scale and demographics reached to administer billions of Covid-19 vaccines, the existing inequities continue to cost lives and prolong the pandemic by increasing the threat posed by the emergence of new, potentially more dangerous variants of the virus.

"In order for the world to continue to make meaningful progress on closing the global vaccine equity gap, we urgently call on countries to set ambitious targets backed by concrete plans for implementation – prioritising full coverage of high-risk groups – and on all partners to coordinate on providing countries with the resources needed to accelerate and expand national strategies, stimulate demand and overcome operational bottlenecks," said a Covax press release.

Reportedly, only 16% of people in low-income countries have received a single vaccine dose – compared to 80% in high-income countries.

In certain lower-income countries, many of the most at-risk people in society – healthcare workers, the elderly and those with underlying health conditions – are going unprotected while young, healthy adults receive booster doses in wealthier countries.

"After a year of severe constraints, we are now in a situation that two years ago would have seemed impossible as the global supply is now high enough to underpin the overarching objective of supporting equitable, full vaccination of all adult and adolescent populations globally," said the press release.

"In accordance with the updated SAGE roadmap of January 2022 – which recommends boosters for priority groups – Covax is now open to and encouraging requests for doses for booster campaigns from countries," it added.

Covax has access to more than enough doses needed to enable 91 lower-income countries that are supported by the Covax Advance Market Commitment (AMC) – which provides donor-funded doses of a wide variety of Covid-19 vaccines – to meet their targets in light of the WHO global target of protecting 70% of the population in each country. 

"We can support these countries to meet individual targets and prioritise full coverage of high-risk groups, however, the next 3-4 months are crucial for accelerating Covid-19 vaccination campaigns."

According to the press release, Covax has shipped over 1.3 billion vaccines to 87 low and lower-middle-income countries around the world in 15 months. The shipments account for 82% of vaccines delivered to low-income countries and the majority of Covid-19 vaccines administered in humanitarian settings. 

The number of countries with coverage under 10% of the population has decreased from 34 in January to 18 in May. Meanwhile, AMC-supported countries like Bhutan, Cambodia, Viet Nam, Maldives, Fiji and Bangladesh have coverage above 70%.

In January 2022, WHO, UNICEF and Gavi established the Covid-19 Vaccine Delivery Partnership (CoVDP), an inter-agency initiative building on existing resources globally, regionally and in-country to support Covid-19 vaccine delivery in lower-income countries. CoVDP specifically provides urgent operational support to the 34 countries that were at or below 10% full vaccination coverage in January 2022, many of which are in Africa. By mid-April 2022, a total of US$ 29 million of urgent funding was coordinated and disbursed – within 15 working days or less – to ten countries across the three agencies. The CoVDP has driven political engagement with several countries with low vaccination rates to keep vaccine delivery on top of the political agenda and identify opportunities for bundling Covid-19 vaccinations with other health interventions.
 
While CoVDP and other efforts are helping lower-income countries make progress, challenges still need to be addressed. In many countries Omicron has reduced the perceived risk of the virus and there are other health priorities that people and governments are focused on. The option of integrating Covid-19 vaccination with other health systems activities – for example, measles and polio campaigns, or the distribution of malaria bed nets – therefore becomes more important. Covid-19 vaccination is also an opportunity to strengthen health systems including training health workers, enhancing health management information systems, further improving the cold chain, and forging new ways of working in fragile and conflict settings.

Although the vaccine demand is highly dynamic and difficult to predict, Covax was able to make some initial estimates of overall demand with the input from governments of the AMC-supported countries.

As per the latest analysis of the demand planning forecasts provided to Covax by these countries, estimated demand from now to early 2023 currently stands at approximately 330 million doses, in addition to what has already been delivered or accepted by countries.

Certainty of supply enables countries to plan national vaccination campaigns with more confidence, ensures a rolling buffer of stock and aids smooth and efficient roll-outs.

Both global and Covax supply now exceeds demand is an advantageous situation in a pandemic, as it guarantees all countries' long term availability of supply and choice of product. 

"Covax experienced delays securing doses in 2021 but with many doses from advance purchase agreements now becoming available alongside donated doses, t is highly likely that overall supply will exceed demand," the press release added.

Meanwhile, Covax is working with manufacturers to help make supply more responsive to the changing demand environment.