Equitable vaccine access for all

The coronavirus pandemic has claimed the lives of more than 2.6 million people globally and disrupted everyone’s lives.

So far, richer countries have been able to buy far more COVID vaccine jabs than poorer ones. But the coronavirus pandemic is a global problem.

“As long as the disease is in some parts of the world, it is going to be putting the rest of the world at threat,” says Meru Sheel, a global health researcher and infectious diseases epidemiologist at the Australian National University.

“It’s not about a country. It’s about all countries, and therefore we need a global plan, because all parts of the world need to be vaccinated at the same pace and have equitable access to vaccines.”

There are several reasons why wealthier countries should care about giving all countries access to vaccinations. At an ethical level, it will prevent severe disease and death among the most vulnerable – the elderly, and healthcare and frontline workers – where the disease is running rampant.

But if idealism’s not enough “viruses mutate when there is community transmission, or there is immunity – a virus may mutate itself to escape the immunity that is induced [by vaccines],” says Sheel.

When the virus is running rampant, there’s a high likelihood of variants emerging that could make current vaccines ineffective. Simultaneously, variants can arise as people are vaccinated because the virus’ pool of possible hosts shrinks.

According to Sheel, the best way to minimise the risk of dangerous mutations is to ensure that all countries have equal access to the vaccine as early as possible. Which is why, she says, the COVAX initiative was launched.

What is COVAX?

The COVID-19 Vaccines Global Access Facility, or COVAX, is a global collaboration co-led by Gavi, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations (CEPI) and the World Health Organization (WHO).

COVAX aims to speed up the development, manufacture and equitable distribution of COVID-19 vaccines by investing in their research and negotiating prices with pharmaceutical companies.

All countries can sign up to COVAX and have access to COVID-19 vaccines as soon as they become available. Any country which joins puts some money into a pool, ensuring that every country can access a broad range of new vaccine candidates. 

So far, 190 countries have signed up to COVAX, pledging $6 billion.

“Australia has played a significant role,” says Sheel. “We were one of the first countries to sign up.”

The Australian Government has made two financial commitments to COVAX – an upfront payment of $123.2 million to allow more than 25 million doses of COVID-19 vaccines for the Australian population (these are extra to the doses purchased through bilateral agreements with Pfizer, AstraZeneca and Novavax) and a further $80 million to support vaccine access for lower-income countries. The government has also promised that all excess doses will be donated to countries in need.

What is COVAX’s plan?

The plan is to distribute 2 billion doses by the end of 2021, which should vaccinate 20% of lower-income nations’ populations and hopefully end the acute phase of the coronavirus pandemic.

Ghana was the first country to receive 600,000 doses of the AstraZeneca vaccine through COVAX on February 24. At the beginning of March, Côte d’Ivoire and Ghana began their vaccination campaign.

But roll out in poorer countries is already lagging behind high-income countries that started vaccinating at the end of last year. According to Sheel “that’s a huge lag”, but she is optimistic that distribution will speed up.

Is the COVAX initiative enough to end the pandemic?

Even if the COVAX target is met, it would still fall short of the level of immunity experts say is needed to end the pandemic: the WHO has estimated that stopping COVID-19 requires at least 70% of the global population to be vaccinated. At two billion doses per year, it would take years before 70% of the whole world’s population receives a vaccine. However, two billion doses would give some protection to health workers, the elderly and the vulnerable.

“The aim right now is to end the acute phase of the pandemic and prevent severe disease in our high-risk populations, so people can start moving around, trade and travel can be restored, economies can be restored,” says Sheel.

“The disease is likely going to be endemic. So we’re going to have to learn to manage it.”

Further reading:

• The myth of ‘living with’ a level of COVID-19
• The immune response to COVID-19 vaccines
• How to read COVID-19 statistics correctly