The cautionary tale of the COVAX Facility

I. POLICY UPDATES

The Geneva Health Files Editorial

The many challenges facing the COVAX Facility

  • With every passing month, the unanticipated challenges facing the COVAX Facility mounts.
  • Take the AstraZeneca vaccine, which has been reckoned as the backbone of the Facility. Rising hesitancy towards this vaccine in the EU and elsewhere because of rare incidents of blood clots, despite the safety of the vaccine vouched by regulators, is only one concern. Following production shortages in the EU that broke out earlier in the year, the barriers to access AZ doses continue — the latest being on account of Indian government’s decision to temporarily hold the export of the vaccine to quell the surge of COVID-19 infections in the country.
  • A concomitant number of factors have come to worsen an already bad situation for the global access to vaccines. Much of the world is now living through the failure of the political leadership at the global level in not anticipating production glitches associated with production of new vaccines. The recalcitrant position of the industry that has not tried to forge path-breaking solutions to meet the sheer proportion of the access challenge facing the world is hard to understand.
  • In the particular case of Serum Institute and the AstraZeneca vaccine, both the Indian government and Gavi have contributed to the delay now facing low-income countries waiting for vaccines from the COVAX Facility. Here’s why.
  • The role of the Indian government in handling the pandemic is one issue, another is its overall lack of preparedness to broad base the pool of production of vaccines, among other shortcomings. (WHO has often been a cheerleader of India’s role during COVID-19, but has rarely, publicly called out some of the approaches taken by the government.) To be sure, India is not unique in the challenges it faces.
  • At stake is not its reputation as a vaccine powerhouse, but also overseeing that contractual obligations of an Indian manufacturer are met. The legitimate need of addressing rising burden of the disease in India is unquestionable. However, in a pandemic, global demands also determine domestic policy-making. Without a deft handling of this, India’s supposed gains on vaccine diplomacy could run dry even before the pandemic runs its course. (As for SII, nearly no company in India can stomach a fight with the government, pandemic or no pandemic.)
  • As Reuters had reported, “India has so far administered more than 54 million doses, of which 49 million are the SII’s locally-made version of the AstraZeneca vaccine. The rest is the COVAXIN vaccine developed in India by Bharat Biotech. The government has so far asked the SII to supply around 141 million doses. The company has also accounted for nearly all of India’s vaccine exports.”
  • Since the beginning of the pandemic, questions have been raised on how Gavi — The Vaccine Alliance, which is spearheading the COVAX Facility negotiated contracts with vaccine manufacturers. An unprecedented global demand for vaccines, meant an attractive opportunity for manufacturers. Why have COVAX partners, on the back of advance purchase commitments and what appear to be lax terms on questions of intellectual property, for example, not been able to ensure timely access for vaccines? The circumstances would have given COVAX a huge bargaining power. How is it that it has resulted in COVAX struggling at the back of the queue, susceptible to the vagaries of state and corporate commitments, despite promises on procuring in bulk?
  • SII has committed to supply more than a billion vaccine doses of AstraZeneca and Novavax to COVAX meant for low and middle income countries including India.
  • Take Gavi’s relationship with SII and India — both seem to be characterised by non-transparency. Top Gavi officials have often underscored India’s special status as a vaccine producer. (This may now come to bite.)
  • The AZ-SII arrangement of licensing is being held up as a shining example of cooperation in addressing this pandemic going forward. We are not entirely sure why. (Critics have also pointed out the role of the Gates Foundation in shaping the terms of this deal.)
  • A lot of these puzzles will likely unravel in due course, by which time a high price would have already been paid.
  • Public statements made by WHO officials associated with the ACT Accelerator, of which COVAX is a part, suggest that authorities were caught off-guard with the constraints facing SII. (One of the biggest short-comings of COVAX was under-estimating the logic of free markets and the resulting bilateral deals.) At a recent briefing, a top WHO official also suggested that price of vaccine doses is not a factor, and that countries prefer access to doses. This is not only untrue, but also insensitive for countries hurting under the worst economic crises in decades.
  • The point is, this challenge is bigger than what certain actors did or did not do. This is not only about Gavi, India or SII, but the lack of a global mechanism more than a year to the pandemic.
  • We also inquired about the mechanism (possibly the COVAX Exchange?) under which European countries, for example, might want to offload AZ doses into the Facility, the question went unanswered.
Image credit: Jeffrey Czum, Pexels
  • Statements made by countries at these crucial meetings which also discussed the TRIPS waiver proposal.

II. WHAT WE FOUND INTERESTING

NEWS:

  • This likely took the staunchest critics of the IMF by surprise.
  • Scathing and timely.
  • Companies such as Pfizer continue to exploit the sellers market in today’s times. We are wondering if countries can bring in legal measures to counter such tactics.
  • The house view is that WHO DG Tedros used the initial virus-origins report as a political tool. We got a very different sense from listening to scientists who worked on the report. And we are glad, that other commentators have discerned this.
  • The reason we find it interesting is, because Vietnam does not support the TRIPS waiver proposal at the WTO.
  • A must-read story that connects the dots across the world. It captures our desperation for cures during COVID-19
  • One of the most definitive stories on airborne COVID transmission with voices from building and construction engineers.

FROM THE JOURNALS / REPORTS:

III. THE WEEK IN TWEETS

Fatima Hassan, Founder, Health Justice Initiative South Africa, says:

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Geneva Health Files

Geneva Health Files

A newsletter from the capital of global health, reporting on politics, policies and power.