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 distributed almost 18 million doses across the region.

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 31 million doses to Latin America by the end of June.

About 57 percent of those doses have already been delivered, meaning about 18 million doses in all. The pace of deliveries has varied across the region, though in general it has been slower than expected. Four countries—Argentina, Colombia, El Salvador, and Paraguay—received all their deliveries slated through the end of June. However, Bolivia, the Dominican Republic, Ecuador, Haiti, Honduras, Panama, and Peru have all received less than 50 percent of their allocations through June. Globally, COVAX has delivered about 68 million doses, which is just 3.4 percent of its goal to deliver 2 billion doses by the end of 2021.

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 worked 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 June 4, just 0.3 percent of vaccine doses had gone to the world’s 29 poorest countries.

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 $10 billion. The largest benefactor of the program is the United States. After initially not joining COVAX, the US became a member when Joe Biden became president, and he pledged $4 billion in funding through 2022. Fundraising efforts have intensified. At a summit hosted by Japan on June 2, 40 donors—including countries, companies, and charities—raised $2.4 billion.

COVAX’s Vaccines

The COVAX Facility is working with seven different vaccine manufacturers on development. 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 720 million doses of AstraZeneca-Oxford, 40 million doses of Pfizer-BioNTech, 500 million doses of Moderna, and 500 million doses of Johnson & Johnson.

However, translating these agreements into delivered doses has proved difficult. About 95 percent of doses delivered so far have been AstraZeneca-Oxford. The first three rounds of allocations only used AstraZeneca-Oxford and Pfizer-BioNTech.

COVAX has plans to deliver other vaccines in 2021.They announced a deal on May 21 to begin allocating 200 million Johnson & Johnson doses, though a delivery schedule is unknown. COVAX’s 500 million Moderna vaccines, which were secured in early May, will begin being delivered in October. Most won’t arrive until 2022.

As of June 1, the WHO has also approved two Chinese vaccines, CoronaVac and Sinopharm, which means either can be used by COVAX. While no deals have been announced yet, CoronaVac may be an attractive option, as it does not require refrigeration.

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 June 4, COVAX had secured 1.7 billion doses. The combined total of doses both secured and optioned is approximated to be 3.9 billion, according to UNICEF.

Countries will soon begin donating doses directly to COVAX for distribution, with the United States donating about 60 million doses to COVAX by the end of June. Within the first tranche of 25 million vaccines it is donating, 6 million will go to Latin America through COVAX. While the European Commission has pledged to donate 100 million vaccines to low- and middle-income countries by the end of 2021, it is unknown if they will distribute any of these vaccines through 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. Venezuela expects to receive its first delivery in July.

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 was supposed to run through May. However, doses from this round are still being delivered. This round supplies AstraZeneca-Oxford vaccines through two producers: AstraZeneca-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 AstraZeneca-SKBio has been slower than expected. Haiti, the only country in the Americas that has not begun its vaccination process, turned down its second-round allocation over fears of the side effects of the AstraZeneca-Oxford 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.

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