By the end of 2022, COVID-19 vaccines delivered by the global vaccine access initiative, COVAX,  helped to avert 2.7 million deaths across 92 lower-income countries, according a new report based on modelling by researchers from Imperial College London.

COVAX’s biggest success was in low-income countries, where its vaccines were responsible for three-quarters of all deaths averted, with 73% of COVID deaths averted in Africa from COVAX vaccines. 

Between January 2021 and December 2022, COVAX delivered 1.9 billion vaccine doses to countries supported by the Advance Market Commitment (AMC), a financing mechanism where doses were largely funded by donor governments to countries that could not afford them.

By the end of 2022, over half the populations in AMC countries had received their full primary vaccines, according to the report, which was released on Tuesday by the global vaccine alliance, Gavi, one of the four key COVAX partners.

The report was released at the start of a two-day “global stocktake” of COVID-19 vaccine delivery, being held in Ethiopia. One of the aims of this meeting is to ensure that COVID-19 services are integrated into primary healthcare.

The modelling is an extension of earlier research published in The Lancet by researchers from Imperial College’s MRC Centre for Global Infectious Disease Analysis.

They explain their methodology thus: “A mathematical model of COVID-19 transmission and vaccination was separately fit to reported COVID-19 mortality and all-cause excess mortality in 185 countries and territories.

“The impact of COVID-19 vaccination programmes was determined by estimating the additional lives lost if no vaccines had been distributed.” 

India vaccine export ban

COVAX’s vaccine supply was sharply curtailed in April 2021 when India, battling a severe COVID-19 outbreak, prevented the Serum Institute of India (SII) from exporting any of its vaccines. SII was to have been COVAX’s main supplier.

As a result, by the end of 2021, COVAX vaccines had contributed to a quarter of vaccine doses in the AMC countries, averting around 857,000 deaths averted – or 13%.

In a collosal understatement, the report acknowledges that “arguably more deaths could have been averted had access to doses not been hindered and had countries received them at scale earlier”.

However, while COVAX’s global market suffered from the export ban, the SII vaccines “contributed significantly to India’s coverage gains that year, which saw more than 850 million people receive at least one dose, with 617 million receiving the complete primary series in 2021”.

India conducted the world’s largest domestic COVID-19 vaccination campaign, and the SII vaccines – 80% of which had been destined for COVAX – averted “an estimated 3.6 million deaths in 2021 alone”, according to the report.

‘A ship built as it set sail’

Describing COVAX as “a ship that was built as it set sail”, the report identifies ”key learnings” in how equitable vaccine access can be achieved as fast as possible for low-income countries and African economies.

To avoid delivery delays, COVAX advocates for: 

• Increased regional supply resilience and manufacturing capacity of life-saving interventions, such as vaccines, particularly across Africa. 
• Transparency by manufacturers regarding their order books so that when delays occur or supplies are limited, it is possible to determine when countries that are unable to afford doses are in danger of disproportionally missing out. 
• Contingency funding and surge capacity to enable global and regional health agencies to pivot during a global health crisis and mount a rapid global response.
• Mechanisms for equitable access to pandemic products like vaccines, therapeutics and diagnostics to be in place before “disaster strikes”.
• Global mapping of existing health solutions, mechanisms, networks, expertise, policies, frameworks and tools, including those created during COVID. It lists the Emergency Use Listing of health, indemnification and liability agreements and the No-Fault Compensation Scheme as examples.

“When COVID-19 hit us, there was no playbook to handle what would become the deadliest global health emergency in 100 years,” said Aurélia Nguyen, Gavi Chief Programme Strategy Officer, and former COVAX managing director.

“The rapid actions of COVAX, which by the end of 2022 had averted 2.7 million deaths, show us how essential a coordinated, multilateral global response is. It also shows the importance of ensuring equitable access to vaccines is built in from the very beginning in any future effort, as many more lives would have been saved if vaccines had reached vulnerable populations earlier.” 

COVAX is the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator, set up to accelerate the development, production, and equitable access to COVID-19 tests, treatments, and vaccines.

COVAX is co-led by the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi and the World Health Organization (WHO), with UNICEF as the key delivery partner for the vaccines.

Image Credits: UNICEF, NPHCDA.