World Health Organization Director-General Tedros Adhanom Ghebreyesus has called on higher-income countries and vaccine manufacturers to support COVAX, the global initiative set up to ensure equitable access to new coronavirus vaccines, instead of bypassing it and prioritizing profits.
“Even as they speak the language of equitable access, some countries and companies continue to prioritize bilateral deals, going around COVAX, driving up prices and attempting to jump to the front of the queue. This is wrong,” said Tedros during his opening speech Monday at the 148th meeting of the WHO executive board.
While countries are right to prioritize vaccinating their own health workers and older populations, he said it is “not right that younger, healthier adults in rich countries are vaccinated before health workers and older people in poorer countries.”
“I need to be blunt: The world is on the brink of a catastrophic moral failure, and the price of this failure will be paid with lives and livelihoods in the world’s poorest countries.”— Tedros Adhanom Ghebreyesus, director-general, World Health Organization
A total of 44 bilateral agreements on COVID-19 vaccines were signed in 2020, and 12 in 2021, according to the WHO chief. He did not identify which countries have made the deals, but according to information from Duke University’s Global Health Innovation Center, they are mostly high- and middle-income countries.
These bilateral agreements have mostly left out low-income countries, many of whom are hoping to access enough vaccines to cover at least 20% of their population through COVAX and start vaccination programs as higher-income countries have already done. Tedros said more than 39 million COVID-19 vaccine doses have been administered in at least 49 higher-income countries so far, but only 25 doses in one low-income country.
“I need to be blunt: The world is on the brink of a catastrophic moral failure, and the price of this failure will be paid with lives and livelihoods in the world’s poorest countries,” he said.
“Not only does this me-first approach leave the world’s poorest and most vulnerable people at risk, it’s also self-defeating,” he added, pointing out that such actions “will only prolong the pandemic.”
The WHO director-general also said that “most” vaccine manufacturers have prioritized getting regulatory approval in rich countries “where the profits are highest,” instead of submitting the necessary documents to WHO for emergency use recommendation. To date, only Pfizer-BioNTech has received WHO emergency use listing for its COVID-19 vaccine.
“This could delay COVAX deliveries and create exactly the scenario COVAX was designed to avoid, with hoarding, a chaotic market, an uncoordinated response, and continued social and economic disruption,” Tedros said.
The WHO leader called on higher-income countries to be transparent in their deals, including regarding vaccine volume, price and delivery dates.
He also asked countries to only use vaccines that meet rigorous international standards for safety, efficacy, and quality.
He challenged WHO member states to ensure COVID-19 vaccines are being administered in every country globally by April 7, which marks the celebration of World Health Day.
Amid WHO’s call for support for COVAX, however, came questions from a member of the executive board.
Dr. Clemens Martin Auer, special envoy for health of Austria’s Federal Ministry of Labour, Social Affairs, Health and Consumer Protection, said the basic principles behind COVAX — ensuring equal vaccine access — are “fantastic” but that it has “substantial shortcomings” when it comes to delivering on its goals. He said the initiative is “slow” and has not closed enough contracts to ensure the delivery of a substantial number of vaccine doses to those who have signed up to the initiative.
Referring to Gavi, the Vaccine Alliance, which manages COVAX, he said the European Union was “skeptical that Gavi COVAX had the means and the capabilities to fulfill its tasks to negotiate the necessary contract[s] and to secure the needs of our citizens.”
He also asked why Gavi did not include mRNA-based vaccines in the COVAX portfolio.
“This was a major mistake,” he said, adding that mRNA-based COVID-19 vaccines were the earliest ones out in the market.
He asked for detailed plans on when and what number of vaccines member states can expect to be delivered via COVAX, adding that these details aren’t clear at the moment.
In an email, a Gavi spokesperson told Devex that the COVAX Facility is on track to reach its goal of securing 2 billion doses of vaccines in 2021 and that they are hopeful about adding an mRNA-based vaccine to the COVAX portfolio soon.
“We are in talks with manufacturers of mRNA-based vaccines and are optimistic a deal could be concluded very soon, perhaps as soon as this week. This would allow us to start delivering doses in February,” the spokesperson wrote.
Published guidance on the vaccine supply forecast for 2021 can also be expected in the coming days, the Gavi spokesperson said. On Tuesday, Gavi, WHO, and the Coalition for Epidemic Preparedness Innovations released a forecast of the COVAX global vaccine supply for this year. The information is broken down by month and provides preliminary details on the vaccine supply among COVAX countries self-financing their doses and the countries eligible for support under COVAX’s advance market commitment.
Jan. 19, 2021: This article has been updated with comments from Gavi, the Vaccine Alliance, and information on the COVAX vaccine supply forecast for 2021.