Wash your hands regularly, wear a mask when you leave your home, keep at least one meter between people. These recommendations have been the order of the day for the world’s population for almost two years. Despite the more or less strict measures taken in the various states, the 2019 coronavirus disease (COVID-19) since its appearance in China in 2019 has infected 130, 969,721 people and caused nearly 2, 849,208 victims worldwide (statistiques covid-19 Afrique – Bing) In Africa, despite figures that were not initially worrying, the second wave is proving much more deadly, bringing the number of deaths to 113,598 in 2021 compared to 318 in 2020 (🦠 Coronavirus nombre de cas en Afrique | En direct (coronavirus-statistiques.com). The availability of vaccines in 2021 to reduce the number of contaminations and the number of deaths that paralyses the activity of all the States has been welcomed as saving news by the populations. However, it has been noted that the vaccines are not necessarily made available in all the states at the same time and that the rate of vaccination is not the same everywhere. The consequences of this remains to be described but the possibility that disproportionate and discriminatory vaccination will impair the overall effectiveness of vaccination to slow down the pandemic is an outcome worthy of consideration The COVID-19 Vaccines Global Access (COVAX) initiative was born to address issues of equity as far as vaccine role out and availability if concerned. The aim of this paper is to make access to vaccines for African countries through the COVAX facility more understandable for the population. , according to the GAVI communications outlet (Gavi, the Vaccine Alliance (2020) COVAX explained | Gavi, the Vaccine Alliance [accessed on 1 April 2021]) the following can be retained concerning the COVAX initiative:
1. What is COVAX?
COVAX is the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator. ACT is a new global collaboration to accelerate the development, production and equitable access to COVID-19 diagnostics, treatments and vaccines. The COVAX arm, launched in April 2020 and coordinated by the Vaccine Alliance (GAVI), the Coalition for Innovations in Epidemic Preparedness (CEPI) and the World Health Organization (WHO), brings together governments, global health organizations, manufacturers, scientists, private sector stalwarts, civil society and philanthropy from 2/3 of the world’s states. The WHO stated in a press release on 24 August 2020 that COVAX had nine CEPI-supported vaccine candidates and nine candidates undergoing trials, giving it the largest selection of COVID-19 vaccinations in the world.
2. Who has access to the Covax facility and what are the benefits?
In principle, all states that have joined the ACT Accelerator have access to the COVAX facility on an equal basis. However, given that both low- and middle-income and high-income countries are participating, COVAX aims to respond to their specific economic situation and needs. Thus, low- and middle-income countries can benefit from financing, while high-income countries secure their access to the COVAX facility through self-financing.
Self-financing countries are guaranteed sufficient doses to protect a certain proportion of their population, depending on the amount of their participation. They can participate in two ways: either through a firm purchase agreement or an optional purchase agreement. Self-financing countries that opt for a so-called firm purchase commit themselves to procuring a defined volume of doses through the facility. In exchange for this firm commitment, these participants will have to provide a lower upfront payment of USD 1.60 per dose, or 15% of the total cost per dose. In contrast, under the optional purchase agreement, participants can choose not to receive a vaccine, without compromising their ability to receive their full share of doses from other applicants, provided that supply is available. This type of arrangement may be more attractive to participants who already have bilateral agreements with manufacturers, through which they may already have obtained sufficient doses of that particular vaccine. The trade-off for these participants, who will have more choice, is that they will have to pay a higher proportion of the total cost per dose upfront, with a down payment of $3.10 per dose and a risk-sharing guarantee of $0.40 per dose to help protect the device from any liability resulting from participants’ decision not to purchase a particular vaccine after the device has already entered into a contract with the manufacturer. In addition, by foregoing their allocated vaccines and waiting for another one to become available, these countries inevitably risk a delay in receiving the full volume of vaccines promised. In the end, the total cost of the vaccines will be the same for both options. Funded countries receive enough doses to vaccinate up to 20% of their population over the long term. Since the number of doses is highly dependent on the availability of doses, it goes without saying that funded countries have limited access to the vaccine compared to self-financed countries under COVAX.
3. What is the situation in African countries?
The vast majority of African countries are low- and middle-income countries, and most of them fall into the category of funded countries. However, given the limited access to the vaccine that this status implies, WHO has set up another mechanism to fully fund access to vaccines for low and middle income countries, the COVAX Advance Market Commitment (AMC), which aims to ensure that the 92 low and middle income countries that cannot afford to pay for COVID-19 vaccines themselves have the same access to COVID-19 vaccines as higher income countries that are self-financing, at the same time. The facility, which has so far raised about $700 million of the $2 billion in seed money needed, is funded primarily by official development assistance (ODA), as well as by private sector and philanthropic contributions. Thus, in addition to deciding how to participate in the Facility, sovereign donors will need to decide to what extent they wish to contribute or allocate ODA to this goal and to do so in a timely manner.
In addition, the financing of vaccines distributed to the 92 Covax recipient states also relies on the transfer of doses between countries. High-income countries that already have bilateral agreements with manufacturers can choose to redistribute them outside their borders through COVAX. In an interview with the Financial Times, Emmanuel Macron, President of France, proposed, among other things, that rich countries transfer 3% to 5% of their Covid vaccine stocks to Africa. (www.Lesechos.fr (February 2021). Vaccins anti-Covid : qui finance le dispositif Covax ? | Les Echos. [Accessed on 1 April 2021]). According to the WHO, 38 African countries have received more than 25 million doses of COVID-19 vaccine Through the COVAX Facility and 30 have launched vaccination campaigns.
4. How are vaccines negotiated and allocated to participants?
COVAX continuously monitors the COVID-19 vaccine landscape to identify the most appropriate vaccine candidates, based on their scientific merit and scalability, and works with manufacturers to encourage them to increase their production capacity before the vaccines receive regulatory approval. The Facility works with manufacturers to provide investments and incentives to ensure that manufacturers are ready to produce the required doses once a vaccine is approved. The Facility will also use the collective buying power resulting from the participation of a large number of countries to negotiate very competitive prices from manufacturers, which will then be passed on to participants. Once one of the vaccines in the COVAX portfolio has been successfully tested in clinical trials and proven to be both safe and effective, and has received regulatory approval, available doses will be allocated to all participating countries at the same rate, in proportion to their total population size. A small buffer of about 5% of the total number of available doses will be set aside to build up a stockpile for acute epidemics and to support humanitarian organizations.
5. Conclusion and recommendations
COVAX is a mechanism whose objective is commendable, especially when one considers the situation of African states. In fact, according to WHO Africa, the mechanism has already made 25 million doses of COVID-19 vaccine available to 38 African countries, 30 of which have launched vaccination campaigns (WHO-AFRICA (March 2021). Available at WHO Regional Office for Africa / Press Release | Vaccination against COVID-19 accelerates in Africa: nearly seven million doses of vaccine administered (africa-newsroom.com) accessed online on 20/04/2021). However, this is still relatively insufficient given that only 7 million doses have been administered, which represents less than “2% of the vaccines administered worldwide”. (France24.com (12/04/2021) available on: Covid-19 in Africa: “The situation of access to vaccines has become practically untenable” (france24.com) accessed on 20/04/2021) This situation can be explained by several factors, notably the problems of shortage, financing, lack of qualified personnel and delivery of vaccines to populations, according to Matshidiso Moeti, Director of WHO Africa, and Mohamed Malick Fall, Director of Unicef (United Nations Children’s Fund) for Eastern and Southern Africa.
To meet these challenges, African states must consider all the possibility to meet the growing health demand. Thus, the focus should be on three things: seeking solutions to obtain vaccines directly from manufacturers outside the Covax mechanism; investing in infrastructure to boost local production of WHO-approved vaccines, which is only 0.1%; and defining an appropriate framework for the use of traditional medicine, which can also be useful in the fight against Covid-19.