Battling ‘supply constraints’, COVAX May Only Deliver 20% Of Vaccine Target By June
The COVAX facility aims to deliver 2.3 billion COVID-19 vaccine doses by the end of 2021.

The global vaccine delivery platform, COVAX, might only deliver 20% of its vaccine target by mid-year because of “supply constraints” but it aims to make up the backlog in the second half of the year, according to Dr Seth Berkley, CEO of the global vaccine alliance, Gavi.

“Our goal is still to try to get to 2.3 billion doses by the end of 2021 assuming that there are not any major supply disruptions with any of the manufacturers,” Berkeley told the World Health Organization’s (WHO) biweekly COVID-19 briefing on Friday.

The Serum Institute of India (SII) recently stopped its vaccine supply to COVAX in order to meet the growing domestic demand as COVID-19 cases in India surge.

WHO Director-General Dr Tedros Adhanom Ghebreyesus said on Friday that there “remains a shocking imbalance in the global distribution of vaccines”.

“More than 700 million doses have been administered globally, but over 87% have gone to high-income or upper-middle-income countries while low-income countries have received just 0.2%. On average, in high-income countries, almost one in four people has received a vaccine. In low-income countries, it’s one in more than 500,” said Dr Tedros.

But only 14 countries were not yet ready to vaccinate their health workers and elderly, said Tedros, who had set Saturday 10 April – the 100th day of 2021 – as the global deadline for this to begin. 

Bilateral Deals and Donations Mean Less for COVAX

Seth Berkley, CEO, Gavi, the Vaccine Alliance.

Berkley called for the “continued support from governments and manufacturers because every time a bilateral deal gets done around the COVAX facility it means less doses for COVAX and for equitable distribution”.

“What we’re now beginning to see is supply constraints, not just of vaccines, but also of the goods that go into making vaccines: the filters, the bags that are necessary, the mediums,” said Berkley, whose organisation manages COVAX, along with the Coalition for Epidemic Preparedness Innovations (CEPI).

However, Berkley added that he expected donations of surplus doses from high-income countries to be “an important source of vaccines for COVAX in 2021”.

COVAX has also been working with multilateral development banks to develop mechanisms to enable low-income countries to buy additional vaccines from COVAX “through cost-sharing mechanisms”. 

So far, COVAX has delivered about 38 million vaccine doses to 105 countries.

“The problem is not getting vaccines out of COVAX. The problem is getting them in,” said Tedros. 

Tedros also condemned “vaccine diplomacy” whereby “some countries and companies plan to do their own bilateral vaccine donations by passing COVAX for their own political or commercial reasons”. 

“This is a time for partnership, not patronage. Scarcity of supply is driving vaccine nationalism and vaccine diplomacy,” he stressed.

China and Russia are the biggest culprits of “vaccine diplomacy”, and both countries have donated millions of doses of vaccines developed in their countries to strategically placed low and middle-income countries, particularly in Africa and Latin America. 

Decision on Chinese Vaccine

Meanwhile, the Chinese vaccines, Sinopharm and Sinovac, which applied for WHO emergency use listing in January, “are in the final stages of evaluation”, according to WHO’s Director of medicines Regulation and Prequalification, Rogerio Pinto de Sá Gaspar.

WHO’s technical advisory group on vaccines would discuss the application on 26 April, and possibly also at a second meeting in the first week of May when the final decision would be reached, said De Sá Gaspar.

Berkley said that there were currently seven vaccine products available, and COVAX hoped that this would be expanded to 10 to 15, but the crucial question was how to expand production.

“There is a COVAX manufacturing task force that is looking at technology transfer and how to expand production, but right now one of the worries is limitations in supplies,” said Berkley, as the global vaccine production was usually 5 billion doses but now needed to expand to 10-14 billion. 

“We don’t yet know exactly what 2022 is going to bring. Will we need new vaccines which are going to replace the existing vaccines? Will we need booster doses because of immunity waning or will we need vaccines that are specifically targeted at some of the variants?”

To finance the demand, Gavi is looking for at least $2 billion in additional funding this year and will be appealing for this at next week’s virtual investment opportunity event being hosted by the US, said Berkley.

Meanwhile, Thomas Cueni, Director General of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), described COVAX reaching over 100 countries as an innovation and manufacturing success story “with the scaling up from zero to one billion doses being produced by April 2021”.

“The COVAX public-private partnership and political leadership to equitably share surplus vaccines are the best guarantees we have that people who need the vaccines will get it whenever they live, fast enough to outpace the virus’ mutations,” added Cueni.

Image Credits: WHO, Gavi/Tony Noel.

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