U.S. Refusal to Join COVAX Puts World’s Poorest at Risk

The United States has refused to join COVAX, the global initiative to ensure widespread equitable access to a COVID-19 vaccine, a decision that has reduced funding and made it likely that millions of the world’s poorest won’t have access to a COVID-19 vaccine in 2021.

Pfizer’s and Moderna’s announcements of promising results of their phase III clinical trials sparked hope in the United States and Europe that a COVID-19 vaccine may start to be available by the end of the year.

But millions of healthcare workers, elderly adults, and other vulnerable people in lower and middle income (LMICs) countries will likely not have access to COVID-19 vaccine until 2022 or 2023 due to lack of funding form the world’s richest nations, especially the United States. Due to insufficient funding, COVAX has not struck a deal with Pfizer or Moderna for advanced purchase agreements, while the U.S. and EU have procured nearly 1 billion doses each.

But experts believe equitable access to COVID-19 vaccine is critical to ending the pandemic.

“Vaccinating only one’s own citizens will not control the pandemic in an era of globalization,” said Dr. Michele Barry, Stanford University Director for the Center for Innovation in Global Health.

The United States has largely abandoned the world’s poorest nations in the race for vaccine development and distribution. The Trump administration has inked deals with at least six vaccine manufacturers to ensure it will have enough to vaccinate the U.S. population.

COVAX, a collaborative effort between the World Health Organization (WHO), the Coalition for Epidemic Preparedness Innovations (CEPI), and Gavi, the Vaccine Alliance, was initiated in April to ensure development and distribution of a COVID-19 vaccine to rich and poor nations.

The goal of COVAX is to secure and distribute 2 billion COVID-19 vaccine doses by the end of 2021- prioritizing healthcare workers and vulnerable elderly adults – specifically to poor countries that are less able to negotiate advanced purchase commitments with vaccine manufacturers.

COVAX has two parts – the COVAX Global Vaccine Facility and COVAX Advanced Market Commitment (AMC)

The COVAX Global Vaccine Facility is relying on donors to secure advanced purchasing agreements with vaccine manufacturers. Currently, 96 countries have enrolled in COVAX Facility.

The COVAX AMC is the financing instrument which will ensure participation of 92 lower-middle and low-income countries in COVAX Global Vaccine Facility. The COVAX AMC has already secured over $2 billion in funding from 96 nations as well as from private donors and philanthropic partners. With these agreements, 92 low-income countries will be able to secure vaccine doses for their population at cost.

So far, the facility has used the pooled funds to secure 700 million total vaccine doses – enough for 350 million people because each person needs two doses — from three vaccine manufacturers: AstraZeneca, Novavax, and GSK-Senofi. The facility has not secured any deals with Pfizer or Moderna.

Throughout 2020, the United States negotiated a bilateral agreement with Pfizer for 100 million doses and an option to purchase an additional 500 million. It also has deals guaranteeing 100 million vaccine doses with AstraZeneca, NovaVax, Johnson and Johnson, and Moderna, respectively.

The EU has similarly secured over 1 billion vaccine doses on a number of bilateral deals with vaccine manufactures.

Poorer countries do not have the purchasing power to make these bilateral deals with vaccines manufacturers, and COVAX was supposed to offer a solution for this financial disparity.

But the United States and EU have used their financial leverage to quickly corner the vaccine manufacturing market leaving COVAX pleading for additional investments. Without such investments they will be unable to negotiate enough advanced market commitments to meet their goal of 2 billion vaccine doses by the end of 2021.

“By the end of 2020, the Vaccines Pillar requires at least US $1 billion for research and development, the Gavi COVAX AMC, and delivery preparedness” a report released Nov. 12 by the World Health Organization said. “And an additional $6.8 billion needed in 2021.”

The World Health Organization says COVAX needs an infusion of $1 billion by the end of the year to buy more vaccines, ramp up distribution and other costs. It predicts it will need $6.8 billion more in 2021.

The EU has invested $500 million in COVAX and the UK has invested $700 million.

During his presidency, President Trump has shown disdain for global health initiatives and has started to withdraw completely from WHO.

“The United States has long been the most generous provider of health and humanitarian assistance to people around the world,” a Sept. 3 statement from the State Department said. “Unfortunately, the World Health Organization has failed badly by those measures not only in its response to COVID-19, but to other health crises in recent decades.”

The withdrawal from WHO was set to be completed in July 2021. But President-elect Joe Biden has pledged to restore full U.S. participation in the body.

Biden is poised to take the White House on January 20, 2021, COVAX provides his administration with an early opportunity to re-establish the U.S. has a leader in the global health arena, and experts are hopeful there could be a change of course.

“Given that President elect Joe Biden has promised US re-entry into WHO, I am expecting the U.S. to engage with COVAX and work towards a solution to equitable vaccine distribution,” Barry said.

Wynee Boelt, a spokesperson for WHO said, “The U.S. has been a vital partner to WHO since its creation in 1948. Together, we have worked to save the lives and improve the health of hundreds of millions of people around the world.”

“With such a highly contagious virus, and in a globalized world, no country will be safe from the fallout of the pandemic until all countries are protected” said Boelt.

“No one is safe until everyone is safe.”


  • Christopher Rios

    Christopher Rios graduated from Harvard College in 2015 with a degree in Neurobiology and Spanish. He started at Stanford School of Medicine in 2017 and is currently an MS4. Christopher is originally from Kansas City, Kansas. He is Puerto Rican and interested in addressing health disparities for Latinx populations at the domestic and international level. After college, he spent a year in Nicaragua working with the Roberto Clemente Clinic to develop a clean water distribution service. After his first year of medical school, Christopher conducted a small research project looking the response of the Puerto Rican health system to Hurricane Maria. In the following September, he accompanied the Latino Medical Student Association to DC and lobbied for increased funding for Puerto Rico. During this same period, he worked with Dr. Michele Barry at Stanford to develop an experimental class with MUBS student in Beirut. As a part of this class, undergraduate and graduate students at Stanford collaborated with MUBS students to learn about a refugee community in Lebanon and develop interventions to address health and education needs. Over the last year, Christopher has been on clinical rotations at Stanford Hospital and Santa Clara Valley Medical Center. He is planning on applying into neurosurgery, emergency medicine, or critical care. Christopher’s primary interest is health disparities, primarily for Latinx populations. Through Stanford Journalism, Christopher hopes to learn how to use media and journalism to tell stories about patients and medicine in a way that is accessible and captivating, and ultimately facilitates empathy and understanding between people of different backgrounds.

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