The COVID-19 pandemic has upended life as we know it for the better part of 2020. With a second wave of the virus well underway around the world, including in Canada, a vaccine against the novel coronavirus is widely perceived as the best way to get the epidemic under control. The world is waiting for a vaccine; however, it is not clear what happens when – and if – a vaccine becomes available.
One of the main concerns about a potential future vaccine is that it will only be available to the highest bidders – developed countries that have the financial resources to make bilateral deals with pharmaceutical companies to buy large amounts of doses once a vaccine is developed. This could prove problematic to achieve global herd immunity, since some populations will be more protected than others.
To prevent an unequal distribution of the vaccine once it is made available, the COVAX Alliance was formed by the Coalition for Epidemic Preparedness (CEPI), Gavi, the Vaccine Alliance, and the World Health Organization (WHO) in April. According to the official description, COVAX was created to act “as a platform that will support the research, development and manufacturing of a wide range of COVID-19 vaccine candidates, and negotiate their pricing.”
COVAX is separated into two initiatives: the COVAX Facility and the Gavi COVAX Advanced Market Commitment (AMC). The COVAX Facility was set up to provide investments and incentives to vaccine manufacturing facilities, so they are able to produce a high number of doses once a vaccine is approved. By committing financial resources to the initiatives, countries can request a number of doses, based on the amount donated.
In tandem with this effort is the Gavi COVAX AMC, a mechanism created to ensure 92 middle and lower-income countries will have access to a vaccine once it is approved. The AMC is not financed by the funds committed for the COVAX Facility. Rather, it is expected to be supported through Official Development Assistance, the private sector and philanthropy. Once a vaccine is approved, COVAX plans to distribute doses through the Allocation Framework already established by the WHO. The current objective is to distribute doses to vaccinate 20% of countries’ populations, and then allocate what is left based on each country’s COVID threat and vulnerability. Furthermore, COVAX has set the goal of distributing two billion doses by the end of 2021.
COVAX could ensure an orderly vaccine distribution once approved, since it equally distributes doses based on need rather than financial capacity. As Dr Seth Berkley, the CEO of Gavi, explained, it is essential to have an equal distribution of vaccines to eradicate the virus: “If only the wealthiest countries in the world are protected, then international trade, commerce and society as a whole will continue to be hit hard as the pandemic continues to rage across the globe.” However, developed countries, including some like Canada that have committed funds to the COVAX Facility, have already started to undermine this strategy by making bilateral agreements with pharmaceutical companies.
As of October 4th, Canada has made bilateral agreements with six different drug companies for around 170 million doses, spending more than $1 billion in vaccine procurement. Procurement Minister Anita Anand explained that the deals allowed Canada to have access to the three main types of vaccine candidates – mRNA, protein subunit, and viral vector – creating a diverse vaccine portfolio. Canada has also contributed $220 million to the COVAX Facility, which corresponds to 15 million vaccine doses. The European Union (EU), which has also signed a commitment agreement with COVAX, has made multiple bilateral agreements with pharmaceutical companies in order to reach the initial vaccination target of 40% (as opposed to 20% for COVAX), securing more than 200 million doses so far.
In public statements, Berkley did not indicate that bilateral deals could impact the efficiency of COVAX. In fact, the COVAX Facility was pitched by Berkley to developed countries as a complement to their own bilateral deals, and an insurance policy if none of the vaccines from bilateral deals are approved. However, unless there is a drastic change in the manufacturing capacities of the industry, there won’t be enough doses to fulfill both bilateral agreements and COVAX’s vaccination objective. When the vaccine will first be approved, only a limited number of doses will be available. By making their own deals with drug companies, Canada, the EU, and other developed countries are undermining the same global commitment they are funding. Every dose distributed as part of a bilateral agreement cannot be purchased by COVAX. Other countries such as the United States are not even funding the COVAX effort, and are relying solely on bilateral deals.
Despite the efforts of CEPI, Gavi, the Vaccine Alliance and the WHO, the distribution of a COVID-19 vaccine might only serve to reinforce existing global inequities. In fact, Oxfam has recently estimated that wealthy nations that represent 13% of the global population have already bought more than half of the promised doses of vaccine candidates. A recent modeling study looked at the impact of two vaccine allocation strategies. First, an uncooperative allocation scenario where the first two billion doses went to high-income countries and the third billion was distributed equally. Second, a cooperative allocation scenario where all three billion doses were distributed to all countries proportional to population. It found that the cooperative allocation scenario would prevent many more deaths (61% versus 31%) than the uncooperative allocation.
Prime Minister Justin Trudeau explained that Canada’s decision to join COVAX would mean “equitable, timely, and affordable access to a safe and effective COVID vaccine, […] critical to help protect people’s health.” However, Canada’s multiple bilateral agreements make it less likely that the distribution of the vaccine will be equitable and timely. It is understandable that each government is trying to secure as many doses of vaccine candidates as possible to protect its own population first. Unfortunately, this approach will likely only benefit a select few countries, while leaving the remaining populations behind.
Evelyne Goulet is a first-year M.A. student at the Norman Paterson School of International Affairs in the Diplomacy and Foreign Policy stream. A recent graduate of McGill University, her research interests include domestic U.S. politics, global health issues, and Canada-United States relations.
Banner image by National Cancer Institute, courtesy of Unsplash.