Vaccination in Colombia (AP)

Vaccination in Colombia (AP)

What Is COVAX and What Does It Mean for Latin America?

By Chase Harrison

The WHO program that seeks to correct for global vaccination inequities has faced ongoing delays.

On March 1, Colombia became the first country in the Americas to receive vaccines through COVAX when a shipment of 117,000 Pfizer-BioNTech vaccines landed in Bogotá.

COVAX, a program run by the World Health Organization (WHO) with the goal of promoting vaccine equity worldwide, promises to deliver 22 million doses to Latin America by the end of May.

But worries are mounting about the deadline because, as of April 22, Latin America has received about 18.5 percent of those doses. Several countries, including Haiti, Panama, and Paraguay, have yet to receive any doses. Guatemalan President Alexander Giammattei publicly called COVAX “a disaster” on April 20.

AS/COA Online explains what the program is and how it is contributing to Latin America’s overall vaccination effort.

What Is COVAX?

COVID-19 Vaccines Global Access, better known as COVAX, is a global platform to support the development, manufacturing, and distribution of COVID-19 vaccines. It was launched in April 2020 by the WHO, the European Commission, and France as one of the three pillars of the Access to COVID-19 Tool Accelerator.

A crucial aspect of the initiative is the COVAX Facility, which is run by public-private global health partnership known as Gavi, the Vaccine Alliance. The COVAX Facility is a procurement mechanism that purchases vaccines from a portfolio of producers on behalf of countries that are COVAX members. The facility has been working with manufacturers to ensure that they had the capacity to produce large quantities of doses once vaccines were approved. Now, the facility is purchasing and distributing vaccines to its member countries.

Vaccine Equity

COVAX seeks to solve the problem of the unequal global distribution of vaccines. As of April 9, 87 percent of the 700 million vaccines distributed worldwide went to high- or middle-income countries. Low-income countries have received just 0.2 percent of global vaccines.

Vaccine nationalism—where countries prioritize vaccinating their own populations before those of other countries—leaves the world vulnerable to an even more protracted pandemic, given that the WHO estimates the coronavirus pandemic will only end when 70 percent of the global population is immune. It is predicted that 500 million people would need to be vaccinated in the Americas region to control the pandemic.

There are two types of countries participating in the COVAX Facility. The first case involves wealthier, self-financing countries. These 90 countries can purchase vaccines through the COVAX Facility to vaccinate 10 to 50 percent of their populations. They must deliver an up-front deposit of 15 percent of the cost to guarantee access to their vaccine order. Unless the prices of the vaccine double, orders put in by self-financing countries are binding. COVAX does offer an Optional Purchase Arrangement in which countries pay a higher up-front cost that allows them to opt out of the agreement later, but they would lose their deposit. Under COVAX, no self-financing country can receive enough doses to vaccinate 20 percent of its population until all countries in the group have been offered vaccines up to this amount. COVAX plans to distribute 485 million vaccines to self-funded countries in 2021. In Latin America, 14 countries are self-financing.

The second group of middle- and lower-income countries are funded ones, and they will not have to pay for vaccines. The doses for these countries are funded by the Gavi COVAX Advance Market Commitment (AMC) program, which raises funds through official development assistance, the private sector, and philanthropy. The vaccine purchases for funded groups come from Gavi COVAX AMC, not the money paid into the system by self-financing countries. That said, the aim of the COVAX Facility is to use the money from self-financing countries and Gavi COVAX AMC to negotiate for better prices and incentivize manufacturers to increase capacity. COVAX plans to distribute 1.8 billion vaccines to funded countries in 2021. There are five funded countries in Latin America.

So far, COVAX has raised $6.3 billion, but says it will need another $2 billion to meet its goals in 2021. The largest benefactor of the program is the United States, which has donated about 40 percent of funds thus far. After initially not joining COVAX, the United States became a member after Joe Biden became president. Biden pledged $4 billion in funding through 2022.

COVAX’s Vaccines

The COVAX Facility is working with seven different vaccine manufacturers. Of these, three have been approved for use by WHO: AstraZeneca-Oxford, Pfizer-BioNTech, and Johnson & Johnson. The WHO’s approval of the single dose Johnson & Johnson vaccine only came in March 2021. In all, the facility has agreements for 270 million doses of AstraZeneca-Oxford, 40 million doses of Pfizer-BioNTech, and 500 million doses of Johnson & Johnson. 

The other vaccines—which are being worked on by manufacturers like Novavax, Sanofi ,and GlaxoSmithKline—have not received regulatory approval and are in various stages of development

As of April 22, COVAX had purchased about 1.1 billion doses. The combined total of doses both secured and optioned by COVAX is approximated to be 3.6 billion, according to UNICEF.

In addition, COVAX plans to run an exchange whereby unused vaccines can be donated to needy countries. French President Emmanuel Macron has said that richer countries should donate 5 percent of their current vaccine supplies to poorer nations, as many wealthy countries have already secured quantities of vaccines several times greater than their domestic needs. Some of these countries, like the United Kingdom, have pledged to provide some of these vaccines to COVAX.

COVAX in Latin America and the Caribbean 

There are 19 countries in Latin America—in addition to the United States, Canada, and 16 Caribbean nations—that are participating in COVAX. Of these, 14 countries are self-financing: Argentina, Brazil, Chile, Colombia, Costa Rica, the Dominican Republic, Ecuador, Guatemala, Mexico, Panama, Paraguay, Peru, Uruguay, and Venezuela. Five are funded: Bolivia, El Salvador, Haiti, Honduras, and Nicaragua.

The only country in the region that has not joined COVAX is Cuba, which plans to vaccinate its entire population using its domestically produced vaccines. Moreover, Venezuela’s membership was at risk after it initially did not make its second payment to COVAX, but it did so on April 18.

Many Latin American countries were hesitant to join the facility due to concerns around financing. In September 2020, 12 countries in the region asked the WHO for an extension on deciding whether to apply for the program. In the end, all decided to become self-financing countries.

The Rollout

Colombia, the first country to get a COVAX shipment, received the 117,000 Pfizer-BioNTech doses March 1 through a pilot program known as First Wave. The program covered 18 countries with Bolivia, Colombia, El Salvador, and Peru representing the Americas. Together, the four received 377,900 Pfizer-BioNTech doses.

The second round of allocations began in February, includes 142 countries, and runs through May. This round was meant to supply Astra Zeneca-Oxford vaccines through two producers: Astra Zeneca-SKBio, located in South Korea, and the Serum Institute of India (SII). However, due to domestic demand in India, SII was unable to export all of its requested doses. Meanwhile, manufacturing at Astra Zeneca-SKBio has been slower than expected. As of April 22, all but two countries in Latin America had received less than 35 percent of the vaccines promised to them between the first and second allocations. Haiti, the only country in the Americas that has not begun its vaccination process, is turning down its second-round allocation over fears of the side effects of the Astra Zeneca vaccine.

The third round of allocations is slated to run from April to June of 2021, concurrent to the end of the second round. The third round will distribute 14.1 million doses of the Pfizer/BioNTech vaccine to 47 COVAX Facility participants: Bolivia, Brazil, Colombia, Costa Rica, the Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Panama, and Peru. There have been no deliveries from the third allocation yet in Latin America.

This article was originally published on February 26, 2021, and has since been updated.