Seth Berkley, former CEO of Gavi, the Vaccine Alliance, has released a new book titled 'Fair Doses.' The book details the establishment and operation of COVAX, an international initiative designed to ensure equitable global access to COVID-19 vaccines.
Inception of COVAX
The concept for COVAX emerged in January 2020 at the World Economic Forum in Davos, Switzerland. Berkley and his colleagues identified the potential need for a global vaccine response to a novel virus originating in China, later identified as SARS-CoV-2. The initiative's core objective was to pre-purchase large quantities of potential vaccines from manufacturers and distribute them to countries based on population size, rather than national purchasing power. This strategy aimed to prevent wealthier nations from monopolizing vaccine supplies.
COVAX Implementation and Challenges
Between 2021 and 2023, COVAX distributed 2 billion vaccine doses globally. Berkley states that this represented the fastest and most equitable vaccine rollout in history at the time. The initial COVAX vaccine delivery to a low- and middle-income country occurred 39 days after the first jab in the UK. Ultimately, COVAX supplied doses to 146 countries, achieving approximately 57% primary dose coverage in 92 lower-income nations, compared to a global coverage of about 67%.
However, the initiative encountered significant obstacles, which resulted in low-income countries experiencing delays in vaccine access, with only about 1% of their populations covered in the first year. These challenges included:
- Vaccine Nationalism: Wealthier nations engaged in pre-purchasing multiple vaccine candidates, which reduced global supply availability.
- Export Bans: Restrictions on vaccine exports, notably by India during the Delta variant surge in spring 2021, severely impacted COVAX's ability to deliver doses. The Serum Institute of India, a primary COVAX supplier, halted shipments, leading to a deficit of 600 million doses.
- Supply Chain Issues: Disruptions in the global supply chain also contributed to delays.
Lessons for Future Pandemic Preparedness
Berkley outlines several recommendations for improving global preparedness for future pandemics:
- Early Funding: Establishing funds on 'day zero' to secure vaccine deals with manufacturers. Gavi reportedly maintains $500 million for this purpose.
- Collaborative Networks: Fostering a network-based approach involving organizations such as UNICEF, WHO, the World Bank, and civil society groups.
- Expanded Manufacturing: Increasing and geographically diversifying vaccine manufacturing capabilities, particularly in regions like Africa, which currently accounts for less than 0.1% of global vaccine production.
Current State of Preparedness
Berkley indicates that global preparedness for future pandemics has declined since January 2020. Factors contributing to this include:
- Misinformation and Disinformation: The spread of inaccurate information regarding vaccines and public health measures.
- Institutional Dismantlement: Reductions in funding and personnel for public health and national security institutions previously focused on pandemic response.
- Political Discourse: Statements from political figures questioning vaccine efficacy or public health protocols.
To enhance preparedness, Berkley emphasizes the importance of adhering to scientific principles, acknowledging uncertainty in initial scientific advice, and transparently communicating evolving information to the public.