Covid-19 vaccination programmes are gathering pace in high-income countries, but for much of the world, the future looks bleaker. Although a number of middle-income countries have started rolling out vaccines, widespread vaccination could still be years away.
The first two Covid-19 vaccines authorised in Europe and the United States – made by Pfizer/BioNTech and Moderna – are not well-suited to lower-income countries. Pfizer’s has to be stored at -70°C, requiring costly equipment and infrastructure, and costs $20 a dose.
Moderna’s can be kept in a standard refrigerator for up to 30 days, but is even more expensive. Low- and middle-income countries have consequently struck few direct deals to buy these vaccines.
Availability is also a problem. Most of these vaccines have been purchased by high-income countries. Pfizer has offered to provide only 50 million doses of its vaccine to Africa’s 1.3 billion people between March and December 2021, while Moderna has none allocated for Africa this year. Fears abound that, for a while at least, the majority of the world will go without.
Backed by the World Health Organization (WHO), the COVAX initiative was created to share Covid-19 vaccines around the world, especially with lower-income countries. In 2020, $2.4 billion was raised, with agreements made to give low- and middle-income countries access to 1.3 billion vaccine doses.
However, the Pfizer vaccine is still the only one that has received WHO emergency use listing, a minimum regulatory requirement for distribution through COVAX. A third western vaccine developed by Oxford/AstraZeneca is substantially lower priced, more easily stored and has large-scale manufacturing partnerships in place, as well as an agreement to supply COVAX, but is still awaiting approval from WHO.
The WHO has stated COVAX will deliver its first vaccines by the end of January at the earliest. By the end of 2021 it aims to have supplied 2 billion doses globally.
But even if this promise is met, it will be insufficient. The total doses pledged by COVAX to Africa will only cover 300 million people, or 20% of the continent’s population.
Speaking on behalf of the African Union, South Africa’s president Cyril Ramaphosa expressed concern that “the COVAX volumes to be released between February and June may not extend beyond the needs of frontline healthcare workers, and may thus not be enough to contain the ever-increasing toll of the pandemic in Africa”.
Not wanting to wait, higher-income countries have bypassed COVAX by cutting direct deals with Covid-19 vaccine manufacturers instead. Increasingly they are being joined by middle-income countries, such as Argentina, Indonesia, South Africa and Turkey, but these nations are turning to different products: vaccines made in India, China and Russia.