8 February 2021

The COVID-19 pandemic is a global catastrophe that has led to colossal loss of lives and livelihoods. Its knock-on impact in lower-income countries is particularly severe. Pre-existing inequities are further exacerbated. More people are falling into poverty, more families are going hungry and more children are dropping out of school. Violence against women and girls is rising. Disruption of essential health services, such as routine vaccination, antenatal care and skilled birth attendance, means millions of children and women in these countries are at risk of disease, disability and death.

Despite these challenges, many lower-income countries have shown extraordinary leadership, innovation, resilience and resolve in addressing and protecting against COVID-19, including through the use of new technologies. New partnerships have been forged with the private sector and civil society at a record speed, and in ways that are unprecedented. We have so much to learn from each other, and we can start by valuing and respecting the diversity of our contributions towards ending this crisis.

For the first time since the United Nations was established, almost every country and economy on Earth is united in the fight against a single enemy: COVID-19. We are united in our suffering, united in our grief and united in our hopes for a healthy future. But in order to bring the pandemic to a swift end, we must also be united in our actions. This means ensuring that every country has equal access to safe and effective COVID-19 tools, regardless of their ability to pay.

Vaccination is a crucial tool in halting the pandemic. With many wealthy countries already rolling out COVID-19 vaccines, lower-income countries need to do the same. The medical and moral imperative for equitable access to COVID-19 vaccines is why COVAX was created. 

Co-led by Gavi, the Vaccine Alliance, together with the World Health Organization (WHO) and the Coalition for Epidemic Preparedness Innovations (CEPI), COVAX is a truly global solution. It is working with governments, manufacturers and financiers to procure COVID-19 vaccines through a global, pooled mechanism, to make them available worldwide to people in both higher-income and lower-income countries.

Involving 190 governments and economies, representing 90 per cent of the global population, COVAX—one of three pillars of the Access to COVID-19 Tools (ACT) Accelerator—enables rapid, fair and equitable access to vaccines. Through Gavi’s innovative financing instrument, the COVAX Advance Market Commitment (AMC), the 92 lower-income economies will receive access to donor-funded COVID-19 vaccines through COVAX at the same time as 98 higher-income, self-financing countries receive their doses.

COVAX already has agreements in place for more than 2 billion doses of several promising vaccine candidates, with the first doses due to begin shipping in February 2021, while negotiations continue for further doses to be secured. While supplies will initially be limited, this is expected to quickly ramp up—such that, by mid-2021, COVAX will have supplied enough to protect all high-risk individuals, including health-care and other frontline workers, and vulnerable groups.

Anuradha Gupta, Deputy CEO of Gavi, the Vaccine Alliance gives oral cholera vaccine (OCV) drops to a child at the launch of the December 2019 vaccination campaign in Cox’s Bazar, Bangladesh. ©Gavi/2019/Isaac Griberg

By the end of the year, COVAX expects to have supplied, and to help with the distribution of, at least 1.3 billion COVID-19 vaccine doses in lower-income AMC countries. To ensure that these vaccines are appropriately and equitably distributed, the bespoke governance system of COVAX was designed with equity and transparency at the core of every policy and process, including the appointment of civil society representatives to key COVAX working groups.

Providing donor-funded doses via the Gavi COVAX AMC, coupled with support for readiness and delivery, will help ensure that lower-income countries do not need to reallocate existing budgets, diverting resources from other vital routine vaccine programmes. This is absolutely essential to sustaining routine immunization services and preventing a spike in vaccine-preventable killers such as pneumonia, diarrhoea, measles and polio.

Preparations, led by WHO, the United Nations Children's Fund (UNICEF) and Gavi, are already well underway for COVAX to deliver vaccines to the 92 Gavi COVAX AMC economies, with Gavi making $150 million available from its core funding as initial, catalytic support for country readiness and delivery. This support builds on the broader investments of Gavi in health system strengthening and routine immunization delivery, which have helped lower-income countries immunize more than 822 million children with life-saving vaccines since 2000, preventing more than 14 million future deaths. The infrastructure created with these investments—from supply chain to skilled health-care workers to disease surveillance—is a strong foundation for effective, equitable distribution and deployment of COVID-19 vaccines in resource-constrained settings.

It is concerning that at the dawn of the largest and most rapid vaccine deployment in history, some governments continue to seek bilateral deals. This creates competition, driving up prices and putting constraints on limited supplies. If this continues, and if manufacturers sell to the highest bidder first, with a promise of doses further down the line, this will only create delays in access that will prolong the pandemic. Without equitable access to COVID-19 vaccines—something that COVAX is built to ensure—the pandemic will continue to rage. After all, in a highly interconnected world, no one is safe unless everyone is safe.

Meanwhile, there are still challenges to overcome in terms of delivery and uptake in lower-income countries: from regulation and approval to prioritization of high-risk groups and service delivery, as well as vaccine hesitancy and misinformation, the challenges are daunting. But in many cases, their nature differs little from some of the challenges that wealthier countries are also facing. As with COVAX, if we put global solidarity before vaccine nationalism, and international cooperation before competition, we just may find more rapid, effective, innovative solutions to protect both rich and non-rich alike.


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