COVAX Update: Enough Vaccines but Big Disparities in Uptake – Exacerbating Risks of New Variants 
Katherine O’Brien, WHO director of Vaccines, Immunizations and Biologicals at the Executive Board Technical Brief.

With the delivery of its one billionth dose last week, COVAX, the WHO co-sponsored vaccine facility, has established itself as the main pillar of vaccine supplies to the world’s 92 poorest economies – providing 82% of the vaccines those nations have received so far.  

But even as vaccine supplies now ease up, huge disparities persist in vaccine uptake rate among low-income countries – with some accelerating their vaccine drives and others stagnating due both to logistical and bureaucratic barriers and slack vaccine demand.  

And even while most of the focus had been put on vaccine delivery – equally large disparities exist in COVID testing capacity – with clusters of low capacity in parts of central Africa. And that increases the risks that new variants could emerge, under the radar, later spreading to the world.  

Those were among the main messages at a WHO technical briefing to the Executive Board, holding it’s 150th meeting this week in Geneva. 

More shipping in last ten weeks than in previous ten months 

COVAX’s one billionth vaccine dose delivery signals that months of  efforts to ramp up vaccine production, procurement and delivery are finally showing results on the ground. Over the past 10 weeks, more vaccines than in the previous 10 months combined, said Kate O’Brien, WHO’s Director of its Department of Immunization, Vaccines and Biologicals, at the briefing.

But multiple challenges are still hindering the effective rollout of vaccine doses globally, she pointed out.

Some 31 countries, including many in Africa and South East Asia, are showing upward trends in vaccination rates, while another 28 remain stable.  However another 20 countries in both regions are even showing declines in vaccination rates, including countries such as Algeria, Angola and Ethiopia. 


“Vaccine supply has substantially improved but challenges remain around short shelf life, doses, transparency from manufacturers on the timing, the variant vaccines and whether their prioritization will be offered to all countries, and the planning on donations,” O’Brien said. 

She added accelerating vaccine delivery capacity, combining intensified efforts and focusing on those left behind are crucial in turning vaccines into vaccination. 

With the unvaccinated still at high risk of falling seriously ill from COVID-19, as well as at risk of incubating more variants, she noted that vaccine demand and confidence are a limiting factor in the impact of vaccines worldwide in all countries. She therefore noted that boosting vaccine confidence remains at the heart of the COVAX roadmap and at the top of individual country’s priority lists. 

“The unvaccinated everywhere remain at highest risk. So vaccine demand and confidence are a limiting factor in the impact of vaccines worldwide in all countries,” O’Brien said.

She also called for an improvement in vaccine products which are presently unable to prevent infections, except for severe diseases.

“There is the need to improve vaccine products to enhance the impacts of the current vaccines. [They] are working especially against the severe end of the disease spectrum. These vaccines will reduce the risk (of severe illnesses) but don’t prevent all transmission or infections,” she added.

Inequity goes beyond vaccines

The staggering inequities in distribution are not limited to vaccines considering there are extraordinary differences across countries regarding COVID-19 testing rates, added Dr Bruce Aylward, Senior Advisor to the WHO Director-General Dr Tedros Adhanom Ghebreyesus.  While rates of vaccination in most of central Africa remain particularly low, so do test rates, he pointed out, citing recent data from accross the world. 

Vaccine rates per capita are lowest throughout central and south-central Africa (in red). Similarly, clusters of low COVID testing capacity persist in parts of the same African regions and Latin America.

“Without addressing these gaps, we cannot understand the pandemic, we cannot direct a treatment and we cannot exit the pandemic,” he said.

Despite its drawbacks, the joint donor-supported ACT-Accelerator initiative remains the only mechanism that is addressing those gaps in the global response to the COVID pandemic, Aylward stressed. Alongside the COVAX vaccine facility, the Act-A’s lesser known initiatives include arms for delivery COVID tests, treatments, and for strengthening health systems, including delivery of essential personal protective equipment (PPE) to health care workers.

“The ACT Accelerator is already making a difference. You can see the big numbers: a billion doses of vaccines, 200 million tests out, 140 Oxygen plants, half a billion dollars worth of PPEs out to countries,” Aylward said.

Act-Acclerator: summary of challenges and strategies to overcome them.


Going forward, he noted that the ACT-A is not only addressing inequity, it’s addressing issues of access in hard-to-reach conflict zones and corners of the world. 

“The accelerator is crucial to the goal of equitable access in exiting this pandemic. This highlights the crucial importance of the accelerator in getting tools to where they’re needed.”

Through the Global COVID-19 Access Tracker, it is also now possible to transparently track progress towards the global targets for access to COVID-19 vaccines, treatments, tests and delivering PPE, Aylward stressed.

US $20 billion is cost of exit ticket out of pandemic – but journey may not be direct

Aylward called upon donors to step up to the bat  in 2022, by responding to the new ACT-A ask for some US$ 20 billion – to fill the requirements of its new strategic plan, issued last autumn. That plans calls for resources to meet the WHO goal of 70% vaccine coverage – along with higher testing and treatment rates – and consistent access to tools like oxygen and healthworker PPE. 

Act-A strategic plan: a $20 billion pricetag

“That is the cost to exit the pandemic [and] that is less than the monthly cost of the pandemic and obviously the trillions of dollars that have gone into its management and consequences so far,” he added.

But success for the accelerator would also require the continued application of more pressure on vaccine manufacturers, Aylward said – restating a longstanding point that reliance on donations of vaccines and supplies from rich countries is unpredictable and inefficient.

The COVAX facility, crippled by the loss of AstraZeneca supplies from India last spring during the Delta wave, now has an increasingly rich array of vaccines in the pipeline – as long as history doesn’t repeat itself.

“We need your support with pressure on manufacturers, let’s be honest, to get access to the new antivirals and specific vaccines that every country in this room wants, to be able to exit the pandemic.”

Meanwhile, Mike J. Ryan, Executive Director of WHO’s Health Emergencies Programme, added that although the pandemic response plans are more robust today than a year ago, they need to remain flexible and adaptive to changing circumstances. 

“Remembering that there are real dangers with virus evolution, real dangers with the emergence of new variants, this may not be a direct A-to-B journey. We must always be ready to change and adjust our strategies to take account of the situation,” Ryan said.

Image Credits: Gavi , WHO/Act Accelerator .

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