COVID-19 vaccine delivery and demand ‘slowing down’

COVAX now has enough supply of COVID-19 vaccine doses to meet country needs, but multiple challenges remain on delivery and demand.

COVAX has delivered more than 1.4 billion doses of COVID-19 vaccines to 145 countries and territories, and 1.2 billion of those doses have gone to countries under the COVAX Advance Market Commitment. Almost half a billion of those doses have gone to 51 countries in Africa, said Eva Kadilli, UNICEF’s supply division director, during an Access to COVID-19 Tools Accelerator media briefing on Thursday.

“COVAX has access to enough supply to enable countries to meet their national vaccination targets,” said Seth Berkley, CEO at Gavi, the Vaccine Alliance. COVAX can also now give countries six months’ visibility on vaccine supply, and launched a Pandemic Vaccine Pool to ensure access to additional and variant-adapted vaccines in case the need arises in the future.

But while supply is no longer an issue, the challenge is on delivery and demand. The omicron variant has changed people’s risk perception of COVID-19, and there remain pockets of hesitancy and low confidence in the vaccines, factors that could be driving the challenges around COVID-19 vaccine delivery and uptake, according to Rosemary Mburu, executive director of WACI Health, an African regional advocacy organization.

As countries deal with other health issues, there’s a need to sustain political will in combating COVID-19, ensure there’s funding for vaccine delivery, and diversify strategies to turn vaccines into vaccinations, she added.

The trends show that both delivery shipments and demand are “slowing down,” specifically during the first and second quarters of 2022, according to Kadilli. The easing of demand for COVID-19 vaccines has taken off the pressure on the syringes market, which faced constraints until the end of 2021, she added.

“But we are supporting together countries to plan carefully so they can have enough syringes in place to address surges, but also overall to ensure that routine immunization also doesn't suffer,” she said.

Another challenge is matching what vaccine countries want and the vaccine supplies coming from COVAX’s advanced purchase agreements and donations from high-income countries.

“The challenge is we try to give countries their first choice of vaccine, and that's important because early on in the days they didn't have a choice and we gave them whatever we had,” Berkley said. “And that makes the matchmaking more complicated across both the advanced purchase agreement doses as well as the donations coming in.” Priority seems to have shifted to messenger RNA vaccines, he added.

That makes it hard to also get countries to take up new vaccines, such as the one developed by Novavax, despite the vaccine’s long shelf life and good temperature portfolio at 2 to 8 degrees Celsius making it a good candidate in rural settings unable to meet ultra cold chain requirements.

“The challenge has been, despite the fact that that vaccine has been offered, we haven't had a lot of orders for it,” Berkley said.

And with regard to the COVAX Humanitarian Buffer, a mechanism meant to act as a “last resort” to ensure vaccine access to populations in humanitarian settings, to date it has only been used to deliver vaccine doses in Iran and Uganda.

“We have other applications that are now pending. We don't make the applications public because there are often sensitive issues in terms of the delivery to those populations, particularly if those are to be done outside of using the normal government systems,” Berkley said.

“We are also … trying to make sure that those populations will have full availability of all of the vaccines and we're not there yet. We still have a number of manufacturers that have not agreed to waive their indemnification and liability agreements for the Humanitarian Buffer,” he added.

Against this backdrop, there are questions about what the second global summit on COVID-19 happening on May 12 and co-hosted by the United States, Belize, Germany, Indonesia, and Senegal could accomplish, especially as the White House struggles to secure additional funding from the U.S. Congress.

Some experts say it’s an opportunity to keep the momentum going to accelerate vaccinations, and for countries to commit to increasing the level of coverage of COVID-19 vaccination among their populations.

“When we think of commitments, we first think of financial commitments and ways to finance vaccine delivery and a continuation of this effort. But it's also an opportunity to elicit and to put on the table programmatic commitments. So countries being able to say, I commit to continue the momentum to go from this level of coverage to that level of coverage, to take special measures to reach some of the high priority groups that we were speaking of,” said Ted Chaiban, global lead coordinator for COVID-19 vaccine country readiness and delivery of the COVID-19 Vaccine Delivery Partnership.