Global vaccine project to revamp rules after Britain gets more than Botswana

  • COVAX assigns early Pfizer injections to vaccine leaders UK, UAE
  • Dose Distribution Method Doesn’t Control State Vaccination Rates
  • Vaccine alliance Gavi proposes changes – internal document
  • UK was one of the few countries with Pfizer freezers, says Gavi
  • Gavi Started Spending $25 Million on Refrigerators in August

BRUSSELS, Sept. 27 (Reuters) – In March, when wealthy Britain led the world in vaccination rates and nearly half of its people had received an injection, the country was awarded more than half a million from the organization that promotes fair global access. until COVID-19 vaccines had to guarantee doses from his stock.

In contrast, Botswana, which hadn’t even started its vaccination campaign yet, was allocated 20,000 doses from the same batch of millions of Pfizer mRNA vaccines, according to publicly available documents detailing COVAX’s allocations.

Other poorer countries, with vaccination campaigns starting at best, also received fewer shots than Britain. Rwanda and Togo were allocated approximately 100,000 doses each, and Libya nearly 55,000.

Distribution was driven by the methodology used by COVAX, a program co-led by the World Health Organization, the Coalition for Epidemic Preparedness Innovations (CEPI), and the Global Alliance for Vaccines and Immunization (Gavi). Since January, it has distributed doses largely evenly among its members based on population size, but regardless of their vaccination coverage.

This made some rich countries, which already had many vaccines through separate deals with drug companies, eligible for COVAX doses in addition to countries without any vaccines at all.

Six months later, COVAX plans to review its allocation methodology to ensure it takes into account the proportion of a country’s population that has been vaccinated, including injections purchased directly from drug manufacturers, according to an internal Gavi document released by has been reviewed by Reuters.

The proposal will be discussed at Gavi’s board meeting on Tuesday, and the change could be implemented in the fourth quarter of this year, the document said.

The COVID-19 pandemic presents an almost unprecedented challenge, and large, sacred institutions like the WHO and the US Centers for Disease Control have at times struggled to keep pace and change course as new data comes in.

When asked why total vaccination coverage was not used as a measure before, Bruce Aylward, a senior WHO and COVAX official, told Reuters that the allocation terms could not be changed without the consent of COVAX’s more than 140 member states, although he did not respond to the process of reaching an agreement.

He added that hard data on vaccine efficacy, which bolstered the case for change, is now available.

“What’s getting interesting now, just in the last few months, is the divergence between cases and deaths from vaccination coverage,” he said.

“We are learning that the single best indicator of mortality risk is the level of full coverage, not just the coverage of COVAX.”


Britain will generally be a net donor in money and vaccines. It has invested 71 million pounds ($97 million) in COVAX, theoretically allowing it to buy up to 27 million doses, and this summer it started donating up to nine million injections, some through COVAX.

Yet there has been a wealth-driven inequality since before vaccines became available, with governments in London, Washington, Ottawa, Brussels and beyond, many of them COVAX members, separately providing large supplies outside the scheme.

In June, COVAX scaled back its initial ambitions to act as a vaccine clearinghouse for the world to focus only on countries deemed most necessary. But within that group, it was still allocating vaccines based on population size, rather than their total vaccination coverage. read more

Since its inception 15 months ago, COVAX has been plagued by vaccine shortages, initially caused by the hoarding of limited doses by wealthier countries.

Subsequently, deliveries were hit by drug manufacturers’ difficulties in ramping up production and export restrictions at the India manufacturing center, which has held up deliveries of many of the 240 million doses of the AstraZeneca vaccine allocated by COVAX in late February.

These problems have reduced the ability to supply poorer countries. It has so far shipped about 300 million doses to more than 140 countries, a long way from the original goal of 2 billion doses by the end of the year, which has now been reduced to 1.4 billion.


The allocation of the Pfizer shots to about 50 countries on March 15 showed the weakness in the COVAX methodology.

The batch of 14.1 million doses was the first major allotment of the US drugmaker’s vaccines in the program, after a small initial batch of 1.2 million injections was distributed to 18 countries in late January, WHO documents show.

At that time, many countries had not yet started their vaccination campaign, mainly due to a lack of vaccines. Even the states of the European Union had to contend with limited supplies.

However, Britain’s vaccination campaign proved successful and had given at least one dose to 40% of the population. Together with the United Arab Emirates and Israel, it led the global ranking for administered doses relative to population, numbers and estimates from One World in Data show.

The country was nevertheless among the main beneficiaries of the allotment, with 539,000 shots delivered in late June, according to Gavi. Only seven countries were allocated more, including the more populous Brazil, Mexico and the Philippines. The UAE was allocated about 200,000 rounds.

The UK government confirmed that it had received about half a million doses of COVAX that it was taking in the country, but declined to specify the delivery date.

Other developed countries invested in COVAX, but some abstained from taking their share of the injections because they could rely on millions of doses from bilateral deals with drug manufacturers.

The UAE has passed on their assignment for March, Gavi said. The UAE has not responded to requests for comment.


The assignment also revealed another source of unequal access, specific to vaccines like Pfizer’s based on new mRNA technology: a country’s ability to process the shots, which had to be transported and stored at temperatures around minus 70 degrees Celsius.

Indeed, only about 50 countries – from Great Britain and Brazil to Angola and Bolivia – could be included in the allocation of Pfizer doses because only they were deemed by COVAX to have the required level of “ultra cold chain” equipment.

That excluded many countries in the developing world.

“A small number of countries were deemed to be ready to receive Pfizer doses,” said a spokesperson for Gavi, when asked to explain why Britain and the UAE were among the first designated recipients.

Gavi initially didn’t consider it a priority to invest in the ultra-cold chain equipment needed for mRNA recordings, according to Gavi’s December public governance documents, as it favored cheaper and easier-to-administer vaccines like AstraZeneca’s. that do not require such extreme temperatures.

Gavi and WHO officials have said this was in line with requests from poorer countries.

Indeed, the 240 million doses of AstraZeneca were allocated to a much larger group of more than 140 countries in February — although export restrictions in India, where the vaccine is made, meant only about 80 million had been delivered by the end of August.

“Preparing an ultra-cold supply chain is a risky business,” said Heather Ignatius, director of advocacy at Path, a nonprofit global health organization, noting that without security of supplies, it wouldn’t make sense to invest in expensive freezers.

However, Gavi changed course on investment in ultra-cold chains in June, when the United States pledged to donate hundreds of millions of Pfizer vaccines to COVAX.

Later that month, Gavi decided to spend up to $25 million on freezers needed to store the vaccine, a Gavi spokesperson told Reuters.

The money began to be spent in August, according to an official familiar with the case. Gavi now plans to supply freezers to about 50 poorer countries through UNICEF, which is responsible for COVAX’s logistics, said Gavi’s spokesperson.

($1 = 0.7289 pounds)

Reporting by Francesco Guarascio @fraguarascio; Additional reporting by Aziz El Yaakoubi in Dubai; Editing by Josephine Mason and Pravin Char

Our Standards: The Thomson Reuters Trust Principles.


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