Introduction

COVID-19 is a rapidly transmissible virus which has shut down the global economy for the past 15 months. In the past six months, vaccine production and distribution has ramped up, but vaccine nationalism—the hoarding of vaccines by countries for their own populations—is threatening to prolong the pandemic for several years. The COVAX Initiative seeks to close this vaccination gap by distributing vaccines to low and middle income countries who otherwise wouldn’t have access to them—an essential step to end the acute stage of the pandemic.

Wealth inequality is the root of the current global vaccine access disparity. As of March 2020, “High-income countries, representing just a fifth of the global adult population (~20%), have purchased more than half (~54%) of all vaccine doses.” 

As shown by this figure from the Kaiser Family Foundation, high income countries have enough doses to fully vaccinate their adult populations twice over, while lower income countries can only vaccinate around a quarter of their population. This poses risks for the spread of global variants, as well as a slower global economic recovery. 

Countries hoard vaccines because they are prioritizing domestic economic recovery and aim to reach herd immunity (with 70% of their citizens vaccinated) within their borders. However, this ideology could end up hurting them more than helping them as variants mutate among the unvaccinated and spread as countries ease lockdowns. This would hinder public health progress and slow economic recovery. Therefore, the COVAX initiative is essential to combat vaccine nationalism by distributing vaccines to low and middle income countries which do not have the same ability to purchase vaccines in bulk.  

The COVAX Initiative

The COVID-19 Vaccines Global Access (COVAX) Initiative is an international partnership led by the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, the Vaccine Alliance, and the World Health Organization (WHO) to close the vaccination gap between high income countries (HICs) and lower-middle income countries (LMICS). It fulfills the vaccine pillar of the Access to COVID-19 Tools (ACT) Accelerator, which was created in April 2020 to ensure that all countries, regardless of GDP, would have access to needed COVID-19 response resources.

COVAX seeks to achieve: 

1. Doses for at least 20% of countries’ populations
2. Diverse and actively managed portfolio of vaccines
3. Vaccines delivered as soon as they are available
4. End the acute phase of the pandemic
5. Rebuild economies

COVAX uses international infrastructure to coordinate equitable vaccine distribution and relies on multiple actors in multiple sectors in order to reduce gaps in vaccination coverage. COVAX aims to provide 2 billion COVID-19 vaccines to the most vulnerable citizens in all participating countries through the COVAX Facility, which is a “global risk-sharing mechanism for pooled procurement and equitable distribution of COVID-19 vaccines.” This initiative seeks to combat vaccine nationalism by recognizing that no country or single population will be protected from the virus if populations in low and middle income countries remain unvaccinated. 

COVAX and US Policy

Changes in U.S. administrative policies on COVAX reflect different ideologies about the United States’ role on the world stage. The Trump Administration did not join or support the COVAX initiative while in office. However, the Biden Administration is now a vocal supporter of the program and has pledged $4 billion dollars to COVAX. They have also supported waiving intellectual property patents on COVID-19 vaccines. This is consistent with the Administration’s foreign policy strategy of rebuilding alliances and repositioning the U.S. on the world stage as a global leader. 

Criticisms and Critiques 

While COVAX is certainly an essential step in the right direction, many organizations feel it is not effectively meeting the needs of the moment. The People’s Vaccine Alliance argues that the COVID-19 vaccines must be seen as a public good and readily available to all those in need, and that COVAX is not the right tool to enable this paradigm shift. These concerns reflect a disconnect between the profit motive of vaccine manufacturers and the imperative to vaccinate as many high risk individuals as possible. In addition, some feel that vaccine hoarding is justified because governments must put the lives of their own citizens before those in other countries. While this does not explain hoarding enough vaccines to vaccinate citizens twice over, it is a main reason why not all countries are ready to give away a portion of their domestic vaccine supply.