Covax and global access to Covid-19 vaccines

The purchasing and administrating of Covid-19 vaccines has been unequal globally. As of 7 January 2022, only 9% of people in low-income countries (having a Gross National Income (GNI) per capita below US $1,045) have received at least one vaccine dose. This compares to 77% in high-income states (GNI per capita above US$ 12,696).

The Covax initiative, which was established in April 2020, aims to ensure fair access to Covid-19 vaccines worldwide. For 92 low-income economies, it plans to donate sufficient doses to vaccinate around 30% of their populations in 2021 and 2022, under its Advance Market Commitment (AMC) scheme. Covax is jointly administered by the World Health Organization (WHO), Gavi, the Vaccine Alliance, and the Coalition for Epidemic Preparedness Innovations.

Covax has struggled to meet its vaccination goals, partly due to difficulties in procuring vaccines, but also the challenges in administering vaccines in countries where logistical and health infrastructure is weak.

At the G7 summit hosted by the UK in June, G7 leaders pledged to donate 870 million doses to Covax by June 2022. This included a commitment by the UK to donate 100 million doses to other countries, including 80 million via Covax. Progress against this pledge is described in the Library’s UK and G7 commitments to donate coronavirus vaccines. 

This briefing describes how Covax works, how many deliveries it has made, and the challenges it faces in administrating vaccine campaigns globally.

How does Covax work?

The Covax scheme uses funding from donor organisations and governments and self-financing member countries to support the research, manufacture, and distribution of Covid-19 vaccines. Covax has procured around 6.5 billion doses of Covid-19 vaccines for its self-funding and AMC participants, including 1.6 billion donated doses.

While its self-financing members, such as Canada, Saudi Arabia and South Africa are required to pay for vaccines procured via Covax, eligible low and lower-middle income economies receive doses for free. This includes Ethiopia, Nepal, and Sudan. To ensure fairness, all states will first receive doses in proportion to their population, until 30% are vaccinated, in the first instance.

Covax’s struggle to meet its vaccination goals

In February 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 December to 1.2 billion (opens pdf) by the end of 2021.

Challenges to supply and distribution 

There are several factors affecting Covax’s ability to procure enough vaccines.

These include the Indian Government halting the export of vaccines in April 2021 as the pandemic worsened there. This affected one of the largest suppliers to Covax, the Serum Institute, which was due to supply a total of 1.1 billion doses. Indian exports resumed in October 2021.

Global manufacturing capacity for vaccines also needed to increase in 2021. In March 2021, the World Trade Organization (WTO) said production needed to triple from 5 to 15 billion in 2021. In September 2021, the International Federation of Pharmaceutical Manufactures and Associations projected that vaccine production may reach 12 billion by the end of the year.

Many high-income countries have also procured more doses compared to low-income ones. In March 2021, high-income countries, which account for 16% of the global population, had negotiated supply agreements amounting to around half the world’s supply.

Countries including South Africa, the US, France and India have also argued that patents and intellectual property rights on Covid-19 vaccines should be waived, as a means of boosting global manufacturing. The UK has argued that the intellectual property rights system has played a “positive role” and generated effective vaccines and therapeutics. Talks at the WTO are ongoing.

The WHO has also criticised many booster campaigns, reflecting fears these may make countries less willing to share vaccines. The UK Government has defended the UK’s booster campaign, stating it is implementing the advice of the Joint Committee on Vaccination and Immunisation.

G7 and other pledges to donate vaccines

In June 2021, G7 members pledged to share one billion vaccines by June 2022. Half will come from the US. 870 million will be via Covax.

The UN and WHO have welcomed the pledge, but urged the doses to be donated during 2021, rather than in 2022. The UK donated 30 million doses to counties by the end of 2021, in line with the government’s target. An additional 70 million doses are intended to be shared by June 2022.