The COVAX initiative: Building Forward Better on post-COVID-19

Javier Surasky 
Program Officer Governance and Financing for Sustainable Development
j.sursky@cepei.org

COVID has exposed many pre-existing inequalities, almost all of which predate the crisis and have been aggravated by it: from the long-standing income gap and access to basic services to the more recent digital divide.  

COVID has also given societies and their leaders the possibility of understanding with greater clarity that every neglected group and violated right implies a problem for everyone, regardless of which side of the divide we are on. Some examples: The difficulty of holding quarantines in slums without access to basic sanitation and with overcrowded homes affected society’s ability to contain the circulation of the virus; The closing of schools did not distinguish between public institutions and the most exclusive schools.

It is clear that the tools to cope with the situation were and are different for one country and another, both within and between countries. This is precisely what the concept of vulnerability is about. In the field of access to treatment and vaccines, the COVAX initiative aims to address this issue.

First step: Inequality, vulnerability and building forward better

There are countless reports explaining what inequality and vulnerability are, as well as their possible causes, effects and ways of dealing with them. We do not intend here to be exhaustive in the survey, far from it, but to make clear Cepei’s position on these issues, which can be reduced to the following statement: any inequality is unacceptable and every vulnerable group expresses a social injustice that must be repaired.

We start from the idea, very close to the full commitment to human rights, that each person is part of a “common something” (the ability to think about the future, to articulate languages, the presence of God… here are explanations for all) and, at the same time, is a unique and unrepeatable being and, therefore, different from all others. This introduces a “tension in the protection of persons” that must both protect this “common something” and the unique individuality of each one of them.

Inequality and difference are two very different concepts, and the former goes against the idea of community among all. Difference is acceptable and worthy of celebration as a source of personal, social and cultural enrichment. Inequality attacks the idea of humanity.

It was 2015, the year when the 2030 Agenda, the Paris Agreement and the Addis Ababa Action Agenda were adopted, the first year in which the richest 1% of the world’s population managed to accumulate 50% of the total population. By 2020, while  the “Decade for Action” initiative was being launched after verifying insufficient global progress towards achieving the SDGs, that sum had climbed to the point where:

Inequality is not only economic. In the last 25 years, for example, the richest 1% of the world has been the source of more than twice as much carbon pollution as that produced by the poorest 3.1 billion people.

On that basis, we can affirm that humanity is being severely challenged. And the idea of humanity, as we put it, is one of the cornerstones of sustainable development, human rights, international cooperation and solidarity.

The examples given above, especially regarding the capacity to assume the effects of COVID-19 and overcome them, are a clear example of the idea of vulnerability, a concept that refers to the capacity of individuals (families or societies, depending on the level of analysis) to face risks – or overcome their fragility – in the face of events that may cause them harm or damage. The lesser the capacity to control and overcome the actual occurrence of these events, the greater the vulnerability. In other words, vulnerability refers to the state of individuals (households or societies) that “varies in inverse relation to their capacity to control the forces that shape their own destiny, or to counteract their effects on their well-being” (Rubén Kaztman: Notes on the measurement of social vulnerability, 2000, page 8).

There are basically three sources of opportunities to increase the capacity to cope with unforeseen events that can negatively affect our lives: the State through its policies, the market through its organization of the distribution of goods, personal networks through containment and support by people close to us.

Linking the ideas of inequality, vulnerability and COVID-19 leads us directly to the key problem to protect people’s lives and build a hinge between the pandemic world and the post-pandemic world: access to treatments and vaccines.

As inequality directly attacks the possibility of solidarity, tackling it in the field of treatments and vaccines against COVID is the only possible way to overcome the pandemic.

While the world is getting poorer as a result of COVID-19, on the other hand, the super-rich or billionaires have become richer, and when entire countries are prevented from accessing vaccines because of their cost, the 10 richest people in the world could pay the cost of the doses needed to vaccinate the entire world’s population.

This trajectory is unsustainable, and now also obviously deadly for the majority. Other paths must be sought.

At Cepei, we use the expression “Build Forward Better”, which we believe is more appropriate for building a post-pandemic world aligned with sustainable development, than the formula “Build Back Better”. Building Back Better is a concept of utmost relevance when thinking about the post-COVID-19 world. Its content is still under construction, although its central ideas are already clearly defined. 

Build Forward Better involves integrating the principle of solidarity with current (“horizontal solidarity”) and future generations (“vertical solidarity”), which lies at the heart of sustainable development, into the processes of managing the effects of COVID-19 and building recovery strategies.

The COVAX initiative was launched as a tool to help address this reality, at least in terms of access to treatment and vaccines.

COVAX: The first Building Forward Better example 

To move forward in building better with equality to fight COVID-19 and its social, economic and environmental impacts, the current moment requires ensuring access to vaccines and treatments against the virus to all corners of the planet. As long as COVID-19 remains active in one place on the planet, the sword of Damocles continues to hang over the heads of everyone. If we accept this, vaccines become global public goods.

Within the conceptualization of these goods, vaccines would be included within the subgroup of “impure” global public goods, that is, their consumption by one person prevents consumption by others (which does not occur in global public goods, such as clean air). This subgroup of goods is a space conducive to competition, but with particularities, given that we also know that these are goods whose enjoyment is only possible if they are for everyone. Thus, even if the application of a dose to one person excludes the possibility of applying it to another, we can only overcome the pandemic if the majority of the world’s population is vaccinated.

And here is where the COVAX initiative appears. Seeking a solution to the problem of the enormous investment involved in research to produce a vaccine, the rush to develop it and the imperative of mass distribution to reach all people, the Access to COVID-19 Tools (ACT) Accelerator Initiative was created in April 2020, presented as a non-institutional collaborative framework that brings together national and international public and private actors in an effort to accelerate the development, production and equitable distribution of COVID-19 test, treatment and vaccines.

The ACT-Accelerator was organized around four pillars: diagnostics, therapeutics, health systems strengthening and vaccines. Within this last pillar, the main working tool is COVAX, a platform launched in April 2020 by the WHO, the European Commission and France and coordinated by the Global Alliance for Vaccines and Immunization (GAVI), the Coalition for Epidemic Response Innovation (CEPI), and the World Health Organization (WHO), in which more than 170 countries of all income levels participate. 

COVAX operates as a common fund of contributions from its members to facilitate all processes related to the mass production and rapid and efficient distribution of vaccines. 

The central idea behind the initiative is that through the creation of a common fund of public and private resources, a diversified portfolio of vaccines can be acquired, allowing their application to at least 20% of the world’s population, following a logic of equitable distribution of available doses. At the beginning of April 2021, when the initiative celebrates its first year of operation, 90 countries are financially contributing to its common fund.

The first step towards equity in distribution occurs when countries contribute to the pool, acquiring doses for a minimum of 10% and a maximum of 50% of their population, the proportion varying according to the amount of the contribution. In any case, COVAX will not deliver vaccines purchased by its fund to countries that have received from the initiative a sufficient number of vaccines to inoculate 20% of their population until all contributing countries receive doses equivalent to 20% of their population. 

Example of vaccine distribution according to COVAX

In addition to the vaccines that reach their contributing countries, COVAX will use its own funds to purchase and deliver vaccines to countries that do not have the economic capacity to contribute or access them on the market. To this end, the Advance Market Commitment for COVID-19 Vaccines (AMC) has been created for the benefit of 92 low- and middle-income countries.

To this purpose, a second fund, the COVAX AMC, has been established, completely independent of the COVAX fund, which is financed by voluntary contributions from States, which will count as Official Development Assistance (ODA), contributions from the private sector and philanthropy.

Since vaccines are purchased by different funds, it is not considered that AMC beneficiary countries must reach the 20% population-to-dose ratio before COVAX contributor countries can receive vaccine quantities above that ratio.

Finally, a total of about 5% of the vaccines acquired will be kept as a reserve to be used in acute outbreaks or given to humanitarian organizations that provide protection to people who would otherwise be left unprotected, such as migrants and stateless persons.

By the end of 2020, COVAX had secured access to 370 million doses of AstraZeneca’s vaccine, with the option to purchase a further 900 million, 500 million doses of Johnson & Johnson’s vaccine, 200 million from Sanofi-GSK and 40 million from Pfizer.

To provide greater security over time to the flow of funds, a third financial instrument has been created, the International Finance Facility for Immunization (IFFIm), which is funded by the future payment commitments made by its contributors. For updated information on the amount and status of contributions to the various funds, click here.

The COVAX initiative raised a total of $2.2 billion in 2020, but estimates that it will need a total of $8 billion in 2021. The arrival of Joe Biden as President of the United States has been excellent news for COVAX. That country went from ignoring it completely in the Trump administration to signing funding commitments for $4 billion, to be delivered in 2021 and 2022, as announced at the G7 meeting in February 2021, where total commitments for new Contributions from the most industrialized countries totaled approximately $8.4 billion. With these contributions, COVAX had a total of $6.3 billion in contributions to be delivered in 2021 at the beginning of the year, bringing it considerably closer to its target.

COVAX: Financing commitments for 2021 (in millions of USD, data as of April 1)

Conclusions

The COVAX initiative was formed by learning lessons from the past: the experience gained from the mechanism for the development and distribution of pneumococcal vaccines was the basis for its constitution. However, this initiative is built from the beginning with a farsighted vision, under the premise of acting today to achieve a different tomorrow, combining elements of the fight against the consequences of inequality, vulnerability, COVID-19 and the premise that there are no individual solutions to global problems.

Its operation is not free of difficulties and setbacks, but still it has already started with its first round of vaccine delivery, from which both developed and developing countries are benefiting.

On February 24, 2021, Ghana became the first country to receive vaccines from the COVAX initiative. Since then, deliveries have not stopped: by early April 2021, 55 countries have received their first doses.

Countries that have received vaccines provided by COVAX, according to the number of doses received

Countries that have received vaccines provided by COVAX, according to the percentage of their population that represents the number of doses received (*)

The total number of doses delivered by COVAX as of April 5 is 17,651,620, representing an average of 1.10% of the population of its target countries. Real-time tracking of vaccine deliveries by the COVAX initiative to countries in Latin America and the Caribbean is available on the Pan American Health Organization’s website. Data is showing much more than a promising start. 

COVAX is the first practical example of what building forward better is all about. It shows how concerted multilateral action is the way to overcome the situation we are in today. 

At the COVID-19 Data and Innovation Centre, we are following its progress, contributing to the transparency and dissemination of data on its efforts, and creating our own information based on combining sources that may be useful for better tracking the evolution of the global vaccination campaign that is already underway.