By: Thandiwe Kubere

COVAX, the multilateral mechanism for equitable global access to COVID-19 vaccines launched in 2020, closed on December 31, 2023, having averted an estimated 2.7 million deaths in AMC lower-income participating economies. COVAX has so far supplied nearly 2 billion COVID-19 vaccine doses and safe injection devices to 146 economies, those including that of Lesotho.

The COVID-19 pandemic has demonstrated the clear need for the world to be better prepared the next time a public health emergency surfaces.  COVAX Partners enlightened that Rapid and equitable global access to medical interventions, such as therapeutics, diagnostics and, in particular, vaccines, which offer the best line of defence for vaccine preventable diseases, will be key to this.

The vaccines pillar of the Access to COVID-19 Tools Accelerator (COVAX) was created at the beginning of the pandemic to enable access to potential COVID-19 vaccines to the most vulnerable everywhere in the world, regardless of income level. Bringing together the expertise and resources of four established institutions across the global vaccine ecosystem jointly leading the process – the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, the Vaccine Alliance (Gavi), the World Health Organization (WHO) and the United Nations Children’s Fund.

Drawing on the lessons of the pandemic, WHO’s report outlines that when the majority of countries missed out on vaccines, COVAX partners advocated from the earliest stages of the COVID-19 emergency that “no one is safe until everyone is safe” – urging the world to place vaccine equity at the heart of the global response, and calling for every country to have at least enough doses to protect those most at risk. “By the end of 2020, 190 economies of all income levels had signed agreements to participate in COVAX, making it one of the most significant multilateral partnerships of the 21st century”, enlightened the report. By November 2020, it had raised US$ 2 billion towards vaccine procurement; and in January 2021, 39 days after the first vaccine administration in a high-income country, the first COVAX-supplied doses were administered in a lower-income country.

COVAX was designed as an end-to-end coordination mechanism encompassing R&D and manufacturing, policy guidance, vaccine portfolio development, regulatory systems, supply allocation and country readiness assessments, transport logistics, vaccine storage and administration, and monitoring country coverage and absorption rates. However, as an emergency solution launched in the midst of the pandemic, COVAX faced many challenges. WHO report revealed that without having any cash reserves up front, COVAX was initially limited in its ability to sign early contracts with manufacturers, and while it was able to ship doses to 100 economies in the first six weeks of global roll-out, export bans and other factors meant that large-volume deliveries were only received in the third quarter of 2021.

While COVAX was unable to completely overcome the tragic vaccine inequity that characterized the global response, it made a significant contribution to alleviating the suffering caused by COVID-19 in the Global South. To this day, the initiative has supplied 74% of all COVID-19 vaccine doses to low-income countries during the pandemic; and in total, 52 of the 92 AMC-eligible economies relied on COVAX for more than half of their COVID-19 vaccine supply.

The national governments, health and frontline workers, civil society organisations and others played a role in ensuring that those doses are delivered free of charge and combined with nearly US$2 billion in delivery support, helped to lift primary series coverage among the 92 AMC-eligible economies to 57%, compared to a global average of 67%. Two-dose coverage of health care workers, those most critical to saving lives and keeping health systems running, stands at 84% in lower-income economies.

“Millions of people are alive today who would not have been here without COVAX. Those averted deaths mean mothers can continue to nurture their children, and grandparents can enjoy watching future generations flourish,” said Jane Halton, Chair of the Board of CEPI. “Despite being built and funded from scratch amid the deadliest pandemic the world has seen in more than a century, COVAX’s life-saving accomplishments were considerable. It should take its place in history and be proud of what it was able to accomplish but also serve as a reminder to us all that we can and must do better next time.”

The Chair of the Board of Gavi, the Vaccine Alliance José Manuel Barroso said COVID-19 has been the greatest health challenge, and it was met with innovation and partnership on an equally unprecedented scale. “COVAX’s impact has been historic, as are the insights it has generated on how, concretely, the world can do better next time. As we transition COVID-19 into Gavi’s routine programming, we do so with deep gratitude for the passion, dedication and sacrifice of so many around the globe who fought tirelessly for three years to try and create a more equitable world – and with an unwavering commitment to improve by transforming learnings into tangible action.”

“The joint efforts of all partners to ensure an equitable response to the pandemic helped protect the futures of millions of children in vulnerable communities,” said UNICEF Executive Director Catherine Russell. “This huge and historic undertaking is something we can be collectively proud of and build on. UNICEF will continue to deliver vaccines to the world’s youngest to stop the spread of all preventable diseases and build strong health systems for the future.”

WHO Director-General Dr Tedros Adhanom Ghebreyesus enlightened that the market forces alone would not deliver equitable access to vaccines and other tools and the creation of ACT-A and COVAX gave millions of people around the world access to vaccines, tests, treatments and other tools who would otherwise have missed out. “COVAX has taught us valuable lessons that will help us to be better prepared for future epidemics and pandemics”, he said.

COVAX’s successes and challenges in the bid to overcome inequity have underscored the clear need for the world to be better prepared the next time a viral threat with pandemic potential emerges. WHO enlightened that the lessons from COVAX’s unique effort must be considered in the development of future global pandemic preparedness and response architecture.

Those include strengthening existing capacity by designing, investing in and implementing an end-to-end solution to equitable access ahead of time, one that centres on the needs of the most vulnerable; recognising that vaccine nationalism will persist in future pandemics and putting in place mechanisms to mitigate it – including by diversifying vaccine manufacturing so all regions have access to supply; and accepting the need to take financial risks to avoid potentially deadly delays to the development, procurement and delivery of medical countermeasures.  

With collaboration from manufacturers, all of COVAX’s advance purchase supply agreements will have been completed or terminated by the end of 2023, with the exception of one, where a modest volume of supply will continue into the first half of 2024 in support of the new COVID-19 routine immunization programme.

Moreover, the report deliberates that investment in African Vaccine Manufacturing Accelerator (AVMA) will make up to US$ 1 billion available to support vaccine manufacturing on the African continent. In addition, a First Response Fund will be established to ensure financing for a vaccine response is immediately available in the event of a future pandemic. It also includes funding “The Big Catch-up” effort designed to fill the gaps in immunization resulting from the pandemic which are now causing outbreaks of vaccine-preventable diseases around the world and threatening the achievement of Immunization Agenda 2030 goals.