What lies beneath the troubled COVAX program

The COVID-19 Vaccines Global Access, more well-known for its other name COVAX, was designed for the purpose of equitable vaccine procurement and distribution across the world. The result was largely loud but immaterial support from wealthier national governments, whose participation was essential for the success of COVAX. In 2022, two years after COVAX was launched, vaccine distributions are still far from equitable, as the majority of vaccine supplies were purchased by wealthy nations well before COVAX was able to procure any substantial amount for itself. This article explores the global pandemic reality, the particular mechanism of COVAX, and the saddening international development that led to the status quo. The article ends with commentaries on the current state of international politics and the direction of our human will and civilization.

An AstraZeneca vaccine vial supplied by COVAX An AstraZeneca vaccine vial supplied by COVAX, seen during a Vaccination Day for nurses and health personnel in Guatemala, March 23, 2021; photo by Víctor Sánchez via the Pan American Health Organization.

The reality of a global pandemic: The case of COVID-19

Infectious diseases do not discriminate based on national borders. Any human body is a good host to transmit to. And that is why, whenever there is a risk of a global pandemic, alarmed governments around the world would strategize to safeguard their citizens, such as travel restrictions and bilateral deals with pharmaceutical companies to secure vaccine supplies. This happened in the 2009 H1N1 pandemic, and it played out again in the COVID-19 pandemic: dominant global powers, such as the US, UK, and EU initiated campaigns and drives to secure vaccines for their own regions, from pharmaceutical companies such as AstraZeneca, Pfizer, BioNTech, and Moderna, whose vaccines showed the most promise. If vaccinations could secure humans permanently from COVID-19, then these regions could be assured of their safety from infection. However, infectious diseases mutate. The more they survive and transmit via their hosts, the higher probability a more infectious or deadlier virus might evolve. The virus itself strives to survive as a species, like humans, and mutation is their strategy. For humans to survive, however, adaptation is also crucial. To deal with viral mutations, vaccinations would fall short if they cannot prevent future mutated strains from attacking human hosts. This is the reason why, for a global pandemic, and for the purpose of security of everyone, vaccinations must also be delivered and administered globally, evenly, and swiftly. If certain regions were left out, and the virus allowed to mutate freely, something like the Omicron variant might happen again, with the potential to kill and infect more people despite vaccination and travel restriction efforts.

However, global vaccination coordination is very complex. The development of vaccines is already complicated in their own rights, which involves thorough testing in three phases and approval from governments (like the Food and Drugs Administration in the US). After they are tested and approved, delivery poses further problems. Many vaccines require the necessary supply chain infrastructure to deliver, like the Pfizer-BioNTech shots that require as much as -60°C cold storage during delivery to not spoil. For countries with such technologies and wealth, this might not be an issue. But large portions of the world, such as many parts of Africa, do not have such supply chain infrastructure, otherwise called “cold chain” – an uninterrupted refrigerated supply chain. If shots cannot be delivered without them being spoiled, people cannot be vaccinated. On top of logistical difficulties, pandemic denial, corruption, and regional conflict all contribute to the challenges facing an effective global rollout of vaccines.

A worker in Ethiopia seen handling the ultra-low temperature freezers A worker in Ethiopia seen handling the ultra-low temperature freezers, which are essential for storing certain COVID-19 vaccines, lest they spoil. The freezers were delivered by UNICEF through COVAX to Ethiopia with the support of the German government, in September, 2021. Photo via UNICEF Ethiopia.

Humanity has tremendous energy to act when there is a willingness to act. Our technological advance is a testament to that. No matter how complex the system is, we could always find a way to accomplish our objective. Commercial space flights, eerily intelligent artificially trained computers that can beat Go masters, and simply making a device called Amazon Echo, which draws materials and labor from countries around the world with logistics beyond imagination, all required incredibly detailed planning and execution. The supply chain is complex by default in our globally connected economy, but when there is the willingness to move a product through this chain, usually motivated by profit, then the chain can be extraordinarily well-oiled and smooth. Such is not the case for vaccine delivery to poorer nations, which are more exposed to the virus, and more prone to viral mutations and their devastations.

The hope of equitable vaccine access across the world

This is the reason that COVAX, or COVID-19 Vaccines Global Access, was established. During a meeting by the heads of two global vaccine organizations, the idea of COVAX was born. It is essentially “pooled purchases”. It relies on the idea of securitization. Basically, to make a deal with a single vaccine company might be risky, because the company might fail at any phase of vaccine trials, might not be approved by government agencies to be used, or might encounter obstacles in manufacturing that delay or fail deliveries. These are all risks. It is much lower in risk to make deals with multiple companies so that even if some might fail to deliver, others might succeed. This is the way to secure investments in companies, otherwise called “securitization.” However, to secure investments, one would need even bigger sums of money. Countries with deeper pockets can afford securitization, and sign contracts that would promise vaccine orders in advance, while poorer countries could not compete. For pharmaceutical companies, billion-dollar investments and deals are always welcomed more than what poorer countries could afford. This leaves poorer countries with very few options to secure vaccines for their populace, because they might need to wait until a vaccine has been tested and approved to make their own bilateral deals, lest advance orders placed with a single company might fail completely, effectively voiding the entire investment. Here, financial prowess is used to foreclose poor countries’ opportunities in placing vaccine orders.

The idea of COVAX is to encourage nations around the world to pool their investments together, so as to prevent the above scenario from unfolding. This is quite like a crowd-funding campaign. Those with more money could fund more, and those with less money fund less. With a very large pool of investments, COVAX can then invest in many more different pharmaceutical companies that develop COVID-19 vaccines. The bigger the pool, the bigger the investment, the more companies are invested, and the smaller the risk. This would seem to be a happy collaboration for everyone involved. However, unlike a crowd-funding campaign, in COVAX, each country would be delivered vaccines evenly to achieve an even global vaccination rate. Those who fund more into COVAX would not be guaranteed more vaccines. There lies the lack of incentive for richer countries to participate. The mentality for any deal is, with any amount of investment wanting more in return. COVAX essentially relies on the goodwill of national governments, that they would do the “right” thing despite losing control over vaccine procurement. This is, of course, erroneous, because national governments significantly deviated from what COVAX hoped for, historically and presently.

The troubled COVAX program

COVAX was launched in April 2020 by WHO, CEPI, Gavi, and UNICEF, in the hope that countries would participate in the program before making deals with vaccine-makers. In the next month, the US Department of Human Health and Services (HHS) struck a bilateral $1.2 billion deal with British biopharmaceutical business AstraZeneca to secure 300 million doses of vaccines for the United States. This was done outside of the COVAX program. In July 2020, HHS struck another deal with US-based Pfizer and Germany-based BioNTech, placing an advance order of 100 million doses of BNT162 vaccine candidate for $1.95 billion. In the next month, the White House announced a $1.5 billion deal with Moderna Inc to secure $100 million doses. Deals were also made with Johnson & Johnson, Sanofi SA, and others, with a total of 500 million doses of vaccines secured by the US up to that point.

By around the same time, the UK government had also secured 340 million doses of vaccines from companies such as AstraZeneca, Pfizer/BioNTech, Valneva, and Novavax. By the fall of that year, Canada had also secured, from similar companies, “at least 88 million doses with options to obtain tens of millions more,” according to Canadian Prime Minister Justin Trudeau. In August that year, Director General of the World Health Organization Tedros Adhanom Ghebreyesus urged global equitable distribution of vaccines and warned against “vaccine nationalism”, which would only exacerbate the pandemic.

What was happening was obvious. In the official statements made by national governments and international organizations, the naked reality of self-interests was covered by reserved criticisms and self-righteousness. Facing the reality of a global pandemic, which cannot be cured unless it is cured globally, governments still decided to strike deals bilaterally with vaccine-makers instead of procuring vaccines through the COVAX program, which would share the fruits of their investments with poorer nations. This, of course, isn’t the first time it has happened. During the 2009 H1N1 influenza pandemic, rich countries had seized almost all supplies of vaccines in development, with little effort to distribute the vaccines evenly across the world.

The idea of pooled purchases and even distribution, offered by COVAX, is a new iteration of past strategies to incentivize rich nations to help poorer nations in vaccine production and delivery. This new program, informed by a financial mindset of securitization, is packaged with non-incentivized moral obligation. In the end, a deal isn’t made for morality’s sake until morality becomes beneficial. By the end of 2020, with more than half of promising vaccine supplies bought by rich nations, the European Union drafted its separate plan to donate 5% of its procured vaccine supply of 1.3 billion doses. Not only was COVAX bypassed in this draft, but the donated vaccines would be labeled as “Team Europe,” according to the internal document seen by Reuters. Although the move was yet to be agreed upon by all EU states at the time, it was laden with the EU’s geopolitical interests in the Global South, and to performatively demonstrate that the EU had not forgotten their poor neighbors.

UNICEF and Nepalese personnel seen holding a sign. UNICEF and Nepalese personnel seen holding a sign with the US national flag in front of boxes of Pfizer vaccines delivered through the COVAX program, October 25, 2021; photo taken by US Embassy Kathmandu.

COVAX saw further setbacks in March 2021, when India blocked its exports of domestically manufactured AstraZeneca vaccines to battle the rise of Delta-variant infections within its borders. India’s Serum Institute, which made deals with COVAX to supply 200 million doses to the Global South, only resumed exports to COVAX six months later. During this six-month period, from March 25 to November 26 of 2021, the “share of people who completed the initial COVID-19 vaccination protocol” (fully vaccinated) in the United States rose from 16.81% to 60.18%, in the United Kingdom from 4.41% to 67.85%, in Canada from 1.76% to 76.09%, in the European Union from 4.42% to 66.86%, and in Africa from 0.24% to 7.02%. The Omicron variant of COVID-19 was first reported to the WHO from South Africa on November 24, 2021.

COVAX faced criticism of its structural failure as it did not include advising bodies from the regions it was trying to help, notably the Africa Centers for Disease Control and Prevention. Such oversight might have led to COVAX being unprepared for vaccine delivery challenges, in the African continent in particular. There was an expectation that, because Africa had experience dealing with Ebola and malaria, COVID-19 vaccines would be rolled out efficiently across the continent given enough vaccine supply. By February 2022, vaccine supply outstripped demand for COVAX for the first time, but gaps in cold chain storage in all parts of the supply chain emerged, and many countries requested vaccines only to the amount they were able to distribute. Specific characteristics of the COVID-19 vaccines, as well as particular local political and infrastructural conditions, were not sufficiently taken into consideration by the COVAX program beforehand. And now that wealthier countries were trying to move away from the pandemic to other geopolitical issues, financial donations to COVAX had also slowed down, posing further challenges for COVAX to uplift vaccine distribution in Africa.

Rich in the will to profit, poor in the will to change

This is the tragic state of the international community. Its proclaimed solidarity and communal development are only pretty veils to cover an ugly reality: me first and you second. International organizations and agencies can continue to condemn, criticize, and warn against this self-centered approach in international politics, but nothing seems to change. Even in the face of a global pandemic that threatens everyone’s safety, national interests still trumped global coordination and collaboration. The rational decision would be to equitably distribute vaccines across the globe, as it would establish a global herd immunity that is truly failsafe. The failure to do so might cause deadlier or more infectious variants to emerge. With no threatening variants in insight, as the Delta variant is almost wiped out by Omicron, and Omicron posing no significant threat to the vaccinated population, there is again little incentive and urgency to drive for the effective delivery and inoculation of the vast populace in poorer countries. At the time of writing, by March 2022, Africa only has 15.18% of its population fully vaccinated, compared to 62% in North America, 65% in Europe, 67% in Asia, and 73% in South America, according to Our World in Data.

What is the solution? We can go back to our tremendous advancement in technology. The record speed with which COVID-19 vaccines were developed attests to the fact of our willingness to act when there is enough incentive, and the efficacy of our action when we truly desire to change. This incentive could be fueled by profit or geopolitical influence, but it could also be fueled by the facing of an inescapable crisis. The inescapable crisis that humanity faces is our self-centered way of living, penetrating from the top of governance to individual citizens. With this self-centered mindset, human security will always be threatened, because the fundamental division between “me and you” creates conflict at all levels, from the office to the market, from the family to the international community. It might be difficult for self-interest to understand that human security has no reward. There is no incentive to prevent conflict. There is tremendous profit and power to be gained from war. The problem is that our will is constantly directed toward profit and power, and we have no will toward peace and security, to a fundamental change in human living. For humanity to be secure, everyone must be secure. If we face a crisis and do not escape, we will act, no matter how complex the situation, how difficult the obstacle, or how dangerous the crisis is. This begins with everyone.

Sadly, humanity still seems ill-prepared for further crises, including another global pandemic. Self-centered thinking, motivated by profit and power, is irrational and subject to political and commercial influence. The “me first and you second” mentality sits at the root of our irrationality. Any crisis would ripple through our interconnected world, in unforeseen ways, bringing other connected crises in its wake. The COVID-19 pandemic brought about profound psychological, economic, and social problems, which are the soil for further problems and conflicts in the family and society. And the assumption that any structural changes would bring about selfless actions from anyone is also ill-informed, not only in historical terms. As stated above, the human will is extraordinarily strong. Any structure, no matter how well-built or philanthropic, is frail against our will toward profit and power. The many issues that plagued our response to COVID-19, such as well-intentioned but naive efforts from international organizations, self-centered and hypocritical national government actors, and the consequent general distrust in government and mainstream media (resulting in denial, conspiracies, and armed conflicts) will come back to haunt us if the root of the issue is not resolved. That is to say, humanity itself must change for any real change to take place, or for human security to be a reality, instead of empty goals and blueprints.

#Pandemic

https://crisisandchange.github.io/assets/authors/yibo-0.0.1.json


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