The Washington PostDemocracy Dies in Darkness

Organization leading Covax could end the vaccine-sharing initiative

A woman and child walk past an informational mural in Kericho, Kenya, portraying the global battle against the coronavirus. (Brian Inganga/AP)

An organization leading the Covax initiative to vaccinate the world against the coronavirus is weighing whether to end the project. It’s a move that would change how global health institutions approach covid-19, experts say, treating it as a routine illness rather than a public health emergency.

At a two-day meeting in Geneva this week, board members of Gavi, the Vaccine Alliance are considering a plan to phase out the vaccine-sharing initiative after 2023, according to an internal board document obtained by The Washington Post.

Gavi is a nonprofit organization that supplies a slate of immunizations to developing countries. It partnered with the World Health Organization and the Coalition for Epidemic Preparedness Innovations (CEPI) to create Covax early in the pandemic.

As of last month, the initiative had shipped more than 1.8 billion coronavirus vaccines to 146 countries, helping low- and middle-income nations access lifesaving vaccines in the middle of a global pandemic. But it has also fallen short of its ambitious targets, critics say, including a recent goal to vaccinate 70 percent of the world’s population against the virus by mid-2022.

Under the current proposal, Gavi would launch a new coronavirus vaccination program in 2024-2025, ending its support for vaccine delivery in 37 middle-income countries, while providing “catalytic financing” for immunization drives there.

The 54 poor countries that traditionally qualify for Gavi funding would continue to receive coronavirus vaccine doses free, and Gavi would cover 70 percent of the estimated total delivery costs.

The proposal to end Covax was first reported by the New York Times. Under the plan, the Times reported, coronavirus vaccine deliveries to the 54 eligible countries would be wrapped into Gavi’s standard immunization program and directed in particular toward the elderly and other vulnerable groups.

The board could sign off on the proposal when its meeting concludes on Thursday, but the initiative’s fate is not sealed. A faction representing several Nordic countries, plus Switzerland and the Netherlands, submitted an amendment to the board that would require further consideration and analysis before Gavi moves to end Covax, according to the document obtained by The Post.

“In the interests of preserving a healthy environment for debate and discussion, we will not be commenting on stories based on confidential Board materials,” a spokesman for Gavi said in a statement Wednesday. The WHO did not respond to a request for comment.

Covax was beset by challenges from the start, including insufficient funding and procurement delays as wealthy countries — including the United States — snapped up doses early in the pandemic.

As of this month, just 68.6 percent of the global population has been vaccinated with at least one dose, according to Our World in Data. In low-income countries, that figure averages about 25 percent.

“The writing’s been on the wall for many months, probably half a year, that Gavi was going to wind down Covax,” said Lawrence Gostin, a global health law expert at Georgetown University.

Two main factors appear to be at play, he said: plummeting demand for coronavirus vaccinations in low-income countries and “a broad, growing, global belief that the emergency phase of covid is nearing its end.”

Why Covax, the best hope for vaccinating the world, was doomed to fall shot

Covax was the main source of coronavirus vaccines to countries in Africa, according to Githinji Gitahi, chief executive of Amref Health Africa, a health development NGO based in Kenya.

“Covax delivered,” said Gitahi, who also serves on a continentwide covid-19 task force. “It did not deliver on time. And the reason it did not deliver on time, and therefore resulted in a big inequity, is that high-income countries hoarded all the available vaccines that Covax was supposed to purchase.”

Over the past year and a half, donations from wealthy countries helped Covax deliver doses to developing countries. But some doses were donated so close to their expiration dates that authorities rejected them or tossed them out.

Now, the global market is awash with coronavirus vaccines. But demand has dropped, even in less-vaccinated regions, in part due to weak vaccine infrastructure and vaccine hesitancy in developing countries, Gostin said.

Waning donor interest may also be at issue in discussions on the future of Covax, said Peter Maybarduk, a lawyer for the advocacy organization Public Citizen who focuses on drug policy.

Soon after taking office last year, President Biden signed on to Covax, which the Trump administration had opted not to join. The United States has since shipped more than 671 million vaccine doses to countries around the world, per State Department figures, but Congress has yet to pass more funding for the global coronavirus response despite repeated pushes by the administration since the spring.

Why Africa is perilously far behind on coronavirus vaccination

To advance global vaccine equity, the most important question is not what happens to Covax, but instead how to build vaccination capacity in developing countries, Gitahi said.

“It’s about saying, ‘What about global systems, and how do we close the inequity permanently, without having to look for short-term vehicles in the future?’”

Rachel Roubein contributed to this report.

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