Editor’s note: This is part one of a two-part series on COVAX.


While developing countries continue to be hit by infectious diseases and epidemics nearly forgotten in developed countries, the entire world is being hit by COVID-19. The pandemic laid bare the ‘healthcare gap’ between developed and developing countries, and far exceeded the ability of charitable organizations to reduce it.

The inability of charitable organizations to reduce this gap will affect not only health outcomes in developing countries, but will negatively affect health services across the world.

  • This article uses Gavi, the co-lead on COVAX, as a model to analyze the outcomes for the COVAX Advance Market Commitment (COVAX AMC) program. COVAX aims to protect almost 30% of the population in 91 AMC economies by early 2022.
  • It also evaluates if the current financing mechanism is the optimal tool to ensure equality in vaccine distribution.
  • Finally, it offers several suggestions that could increase the effectiveness of the program’s outcome.

COVAX AMC adopts an innovative financing mechanism to support 92 low- and middle-income economies. These countries are eligible to participate in COVAX, and are supported by the COVAX AMC through fundraising. The donation process unfolded during an international summit in Japan, where more than 180 countries and economies signed commitment agreements to the COVAX Facility.

The COVAX scheme adopts a number of approved, diverse portfolios of COVID-19 vaccines. According to Gavi’s website, COVAX AMC is the only means to ensure rapid, fair, and equitable access to safe and effective licensed vaccines to individuals in all countries.

The Gavi COVAX AMC Summit (“One World Protected”) was a virtual event hosted by the Japanese government and Gavi on June 2, 2021. The Vaccine Alliance raised roughly US $2.4 billion from 40 governments, private sector stakeholders, and foundations, exceeding the funding target, and bringing the total pledged to the COVAX AMC to US $9.6 billion. On June 13, 2021, G7 Summit leaders donated 870 million vaccine doses to low- and low-middle-income countries over the next year. This pledge will help Gavi secure its required 1.8 billion vaccine doses, the vast majority of them for lower-income countries participating in the COVAX Facility.

At first glance, the COVAX financing mechanism appears to be working effectively, as the actual amount of funds (or the number of donated vaccines) appears to be sufficient to cover more than the desired 30% target. Gauging the effectiveness of the financing mechanism requires analyzing the number of people who received at least one dose of a COVID-19 vaccine in three categories: G7 Countries, Low-Income Countries, and Middle-Income Countries.

This data covers the period between December 13, 2020 and July 26, 2021. For population estimates, we calculated per capita metrics that are all based on the last update of the United Nations World Population Prospects.

The graph shows the significant difference between the number of individuals who received at least one dose of the vaccine in G7 countries versus those in low- or middle-income countries.

The percentage of Canadians who have received at least one dose has exceeded 70%. The rest of the G7 countries rank as follows: the UK, Italy, Germany, France, the U.S., and Japan. It is worth noting that Japan demonstrated its commitment to ending the acute phase of the pandemic by pledging US $800 million at the summit, making their total contribution to the COVAX AMC around US $1 billion.

According to Our World in Data, only 1.1% of people in low-income countries have received at least one dose.

Looking at the graph, it is clear that no more than 3.79% of people in low- and middle-income countries have received their first vaccine shot. Togo boasts the highest percentage, while Syria has the lowest percentage vaccinated, equal to 0.01% of its population. According to Our World in Data, only 1.1% of people in low-income countries have received at least one dose.

The results of the data analysis indicate that the financing mechanism is not the optimal methodology to ensure equality in vaccine distribution, and COVAX is not a truly “global solution” to this pandemic, as Gavi claims.

In fact, the issue of equality in vaccine distribution goes beyond merely a financing mechanism, as there are two main dimensions to the issue.

First, countries must listen to the WTO. While the WHO recommended prioritizing vaccines to medical staff, front-line workers, those over the age of 60, and those with chronic diseases, some countries have neglected this recommendation. It is unfortunate that Canada and all other G7 countries, except for Japan, have opened appointments for those under the age of 18, who are classified, according to the WHO, as less susceptible to complications from COVID19. Further, large numbers of citizens from low- and middle-income countries over the age of 60 have not been vaccinated. Japan, for example, has only allowed the vaccine to be administered to prioritized medical workers and those over 60.

The second dimension of the issue concerns vaccine distribution in countries under economic siege and sanctions (e.g., Syria) or countries that are at war (e.g., Yemen).

The following article, set to be published at the end of August, will discuss this dimension in more detail.


Noora Al-Najjar is a lecturer at King Abdulaziz University in Saudi Arabia and a PhD candidate in Health Policy. She has three master’s degrees in Economics, Public Health, and Health Administration and Hospital Management. Her research interests include developing countries’ economies, health systems, humanitarian aid, health organizations, equity and justice.

Photo Credit: US Mission Geneva.

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