The Promise of COVAX and The Dangers of Vaccine Nationalism

COVAX, an organization that is being co-led by Gavi, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations, and the World Health Organization, is seeking to convince richer countries to invest in their program by citing that they are more likely to gain access to the correct COVID-19 vaccine candidates through their involvement. One of the co-leading organizations behind COVAX, Gavi, hopes that despite the fact that richer countries are independently investing with manufacturers, they will also choose to be a part of COVAX. Therefore, in the event that the vaccines that wealthy countries had privately invested in do not materialize, they will still have access to any COVAX developments and will be able to vaccinate 20% of their population. Additionally, if wealthy countries invest in COVAX it can help guarantee that poorer countries have access to a viable vaccine (given that vaccine was developed via COVAX) at a lower price.

The idea of “vaccine nationalism” is emerging as a result of politicizing public health efforts amidst the pandemic. The United States government’s decision to make private deals with pharmaceutical companies in order to gain access to viable COVID-19 vaccines has greatly contributed to international cooperation failing. The COVAX initiative of equitable access to COVID-19 vaccines will not be possible without the involvement of global powers such as the United States. Without the participation of global powers, other communities will lack access to any vaccines until places like the United States have already vaccinated their entire population.

Despite choosing not to invest in COVAX, the United States has still independently invested in more vaccines than they could possibly need domestically. Despite these billions of dollars that the United States is investing, there is no guarantee that any vaccine currently being developed will work. The growing competition and nationalist behavior of countries such as the United States will inevitably increase the prices of COVID-19 vaccines, drive tension internationally, and may even result in hostilities when it comes to securing enough doses from a very limited supply of vaccines. Higher prices and scarcity of resources will compromise access to vaccines in low and middle income countries, resulting in difficulties in limiting the spread of COVID-19 in these countries. It is important to note that vaccines are never perfect. Thus, if COVID-19 continues to be a pressing issue in any part of the world, it remains a threat to everyone.

When COVAX was officially announced to the world, 16 different vaccines being developed were already in clinical trials, and more than 125 vaccines were in the preclinical stage. By the middle of July, approximately 75 countries announced that they would be contributing to the funding of COVAX. This allowed for 90 low-income countries to subsequently qualify for COVAX as a direct result of the investments made by richer countries. Thus, it is clear why a very wealthy country, like the United States, not joining the COVAX initiative is such a loss for lower-income countries.

With the race to develop a viable COVID-19 vaccine becoming more pressing each day, the COVAX pillar is seeking to manufacture as many as 2 billion doses of a vaccine by the end of 2021. With no vaccine yet viable, the process of assessing potential vaccines is different than the usual process given the circumstances. Adaptive trials will be used to simultaneously carry out different phases of clinical trials (as opposed to sequentially). This allows for quicker vaccine development, while also maintaining the scientific process to ensure a safe vaccine.

In terms of vaccine administration, COVAX is planning to implement different strategies that are region specific – single-dose vaccinations in regions where it may be difficult for people to come back and obtain a second dose (i.e. refugee camps), versus double-dose vaccinations for people who can easily schedule an appointment at a doctor’s office. Vaccines should also be sourced from various international locations so that exporting does not become an issue.

Although the COVAX initiative is very promising and could potentially help to vaccinate billions of people, the largest issue at hand is the manufacturing of a viable vaccine. With patents being so hard to secure, an alternative method is to incentivize international organizations to contribute to this issue could be the Global Health Impact Index. The Global Health Impact project works to encourage contributions to global health through a rating system. So, companies that earn higher rankings have a drug/vaccine that treats a certain disease very efficiently with a large overall global impact. By utilizing this rating system to evaluate the COVID-19 vaccines that are developed, companies will be incentivized to develop vaccines that can earn a high rating, and thus the overall impact on global health and reach of the vaccine will be much greater. Especially in the midst of a global pandemic, the priority must be how the greatest number of people can receive vaccinations in the most effective and cost-efficient way possible.

References

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What is the COVAX pillar, why do we need it and how will it work? Gavi, the Vaccine Alliance. 2020 Jun 26. https://www.gavi.org/vaccineswork/gavi-ceo-dr-seth-berkley-explains-covax-pillar