The biggest effort to vaccinate the developing world is falling apart

Sending vaccines out into the world.
Sending vaccines out into the world.
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Last year, Covax, the facility set up by the World Health Organization and several non-profits to deliver Covid-19 vaccines to developing countries, aimed to secure and distribute 2 billion doses by the end of 2021. By mid-May, though, Covax had shipped out only 68 million doses—a result of various vaccine nationalisms, and skyrocketing demand for vaccines and vaccine supplies.

On May 18, Covax received a further blow. The Serum Institute of India (SII), the world’s largest vaccine manufacturer, announced that it wouldn’t be able to send Covax—or any other client overseas—further shipments of its vaccines until the end of the year. SII was on the hook to supply 200 million doses to Covax, with options of up to 900 million more doses. But given India’s raging second wave of disease, its government’s delay in ordering vaccines, and SII’s struggle to step up manufacturing, all of SII’s production in the near future will be diverted to supplying India first. 

SII’s announcement has left Covax—and, by extension, dozens of countries—in the lurch. Covax’s 2 billion doses were designed to account for 30% of all doses required by 92 lower-income countries. Many nations in Africa, for instance, were depending on vaccine exports from India. It has raised the fear that Covax may have been relying too excessively on SII. (Strive Masiyiwa, the African Union’s special envoy on vaccines, told the Financial Times on Tuesday that he’d warned Covax back in January to “not put all its eggs in one basket.”) The question now is: How will Covax source all the vaccines it needs?

A Gavi spokesperson told Quartz over email that Covax “remains hopeful that deliveries could resume, in reduced quantity, in the third quarter.” This is in doubt. India’s rate of vaccination has slowed drastically, to around 1.356 million doses per day, in large part because of a supply crunch from SII. While SII has promised the delivery of large new orders by July, India has yet to vaccinate over a billion people, which is likely to take the rest of 2021, if not beyond.

The Gavi spokesperson said that Covax’s chief priority now was to raise the funds it needs for its vaccine drive. But out of its target of $8.3 billion, it has already raised more than $6.6 billion. Finding money, it turns out, has been easier than finding vaccines to buy with the money.

Covax is also sending out Pfizer’s vaccines, after the company agreed in January to provide 40 million doses in 2021. As of mid-May, though, only 1.25 million Pfizer doses have been shipped—less than what Pfizer produces in a single day, as the New York Times pointed out.

Covax also has other agreements in place: for 500 million doses of the Moderna vaccine, to be shipped through the second half of 2021 and through 2022; up to 200 million doses of the Johnson & Johnson vaccine in 2021; 350 million doses of the Novavax vaccine, to be supplied from late 2021 into 2022. As yet, none of these have even reached Covax to proceed into distribution; the Novavax vaccine, in fact, has yet to secure all its regulatory approvals.

Even these committed doses might fall subject to export curbs imposed by the countries where they’re manufactured, as has happened with the SII’s vaccines. A new variant may emerge, or a new policy may warrant citizens to get preventive vaccinations year on year, prompting governments to divert doses to their own populations. And companies will keep being solicited by wealthy countries to buy vaccines at full price—another excuse to go slow on Covax promises. Already, vaccine manufacturers have order books stretching into several years; Pfizer, for instance, has agreed to supply the European Union with 1.8 billion doses, well into 2023.

There is, as of now, no alternative to Covax; it is the only facility designed expressly to address Covid-19 vaccine inequity. So unless Covax receives many hundreds of millions of doses to distribute over the course of this year, a likely scenario emerges of the world in mid-2022: vaccination drives sputtering or crawling across the developing world, even as entire populations in the West have received their regimens of shots. New variants mutate into being in incompletely vaccinated countries. New flares of disease result in repeated local, or even national, lockdowns. The global economy falters. The pandemic, patchily but persistently, extends into the foreseeable future.