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The development of Covid-19 vaccines offers a potential pathway towards global recovery.

However, the purchasing and administration of vaccines has been dominated by richer economies. As of 17 September 2021, only 2% of people in low income countries (having a GNI per capita below US $1,045) have had at least one vaccine dose, compared to 67% in high income states (GNI per capita above US$ 12,696).

The UK, Canada and the US are amongst the countries who have also secured agreements for vaccine doses several times their population need.

The Covax initiative was established in April 2020 by the World Health Organization (WHO), Gavi, the Vaccine Alliance, and the Coalition for Epidemic Preparedness Innovations. It aims to ensure fair access to Covid-19 vaccines, and to accelerate their production. For 92 low-income economies, Covax intends to donate sufficient doses to vaccinate around 30% of their populations in 2021-2022.

Funding for Covax is the primary support the UK gives to vaccination campaigns overseas, although the Prime Minister announced in June that the UK will donate 100 million Covid-19 vaccines by June 2022.

This briefing sets out how the Covax scheme works, and the challenges faced in administrating vaccine campaigns in Africa, Asia, and the Middle East. Section 4 details the contributions of the UK and other high and upper-middle income economies to Covax and the distribution of vaccines.

How does Covax work?

The Covax scheme uses funding from donors and self-financing members to support the research, manufacture, and distribution of Covid-19 vaccines. It currently has agreements to offer eight types of vaccine and to potentially purchase up to 4.3 billion doses. Around 740 million vaccines have also been donated to Covax.

While its paying members, such as Canada, Saudi Arabia and South Africa are required to pay for the vaccines procured via Covax, eligible low and lower-middle income economies can receive doses for free. This includes Ethiopia, Nepal, Sudan, Syria, and Yemen. To ensure fairness, all states will first receive doses in proportion to their population until 20% of the population are vaccinated.

Vaccine procurement and the pandemic in India

In March 2021, the rollout of Covax vaccines began. Despite the goal to distribute 170 million doses by 31 May, only 76 million were delivered. In July, Gavi estimated that Covax would deliver 2.2 billion doses by January 2022, but this estimate was reduced in September to 1.4 billion by the end of 2021.

Delays are due to increased domestic demand and the Indian Government halting the export of vaccines as the pandemic worsened in that country. The Serum Institute of India is one the largest global manufacturers of vaccines and was due to provide 1.1 billion doses to Covax. The Indian Government now intends for exports to resume in the final quarter of 2021.

Calls to share vaccines

The WHO set a goal to vaccinate 10% of the population of every country by September, and 40% by December 2021. However, in July the WHO’s Director General, Tedros Adhanom Ghebreyesus, said the world “remains way off” achieving this target.

The WHO has previously called for higher-income countries to delay child vaccines and share doses with Covax. It has also opposed booster programmes, which some countries, such as the UK, are intending to carry out. In September, its Director General said no further booster shots should be administered during 2021 and the doses instead be made available to poorer countries.

In September, the APPG on Coronavirus said the UK Government should share doses to vaccinate low-income countries before giving booster jabs to healthy over-50s in the UK. The Health Secretary, Sajid Javid, has said the Government is implementing the advice of the Joint Committee on Vaccination and Immunisation in administering the booster jabs.

G7 and other pledges to donate vaccines

Several countries, including the US and UK, have pledged to share doses, primarily via Covax. In June 2021, G7 members pledged to share one billion doses by June 2022, half of which will come from the US.  This includes 870 million via Covax, of which half will be delivered by the end of 2021.

Within this pledge, the UK committed to donate 100 million doses by June 2022; 80% will be distributed via Covax. Since April 2020, the UK has committed £548 million to the Covax scheme (this does not include the value of the donated doses).

To September, the UK donated 10.3 million doses: 6.2 million via Covax and 4.1 million directly with other countries. The UK has come to agreements to share doses with countries in Africa, Asia and the Americas. These include Indonesia, Kenya, Antigua and Barbuda, and Thailand. 

In September, the US, Italy and Japan announced they would increase their donations. President Biden pledged to share an additional 500 million doses, bringing the US total pledge to 1.1 billion.

While the WHO has welcomed the G7’s pledge, its Director has said the doses are needed “now” rather than next year. In July, the UN warned that almost 75% of countries requiring humanitarian aid had recorded more cases or deaths from Covid-19 in 2021 than in all of 2020.

Update log 

9 July: Added information on financial pledges to Covax and vaccine rollout in Africa and the Eastern Mediterranean. 

2 August: Added information on UK donation of vaccines and data on Covax. 

22 September: Added data on vaccines shared by G7 states, including the UK. India is also expected to soon resume vaccine exports. Updated Covax projections for number of doses it expects to distribute. The US, Japan and Italy have also announced further donations.

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