On Monday, the World Health Organization (WHO) announced that 64 rich countries have joined its Covax facility for fair distribution and allocation of a Covid-19 vaccine. This writer has previously referred to Covax, a partnership of vaccine developers and countries set up by Gavi, the Vaccine Alliance, the Coalition of Epidemic Preparedness Innovations (Cepi), and WHO, that aims to source and distribute two billion doses of the vaccine by the end of 2021. Another 38 countries are expected to join Covax in the next few days, WHO said. Currently (including the 64), 156 countries are part of the facility under which they will receive the vaccines – with 92 eligible for free or subsidised vaccines. The rich countries will pay for the vaccine, though – their participation is, in effect, a hedge to ensure they have access to a successful vaccine (although many of them have already signed deals with vaccine-makers for hundreds of millions of doses). WHO said on Monday that its alliance now covers 64% of the world’s population. Interestingly, neither China nor the US (the world’s most populous and third most populous nations) are part of the facility. India is part of the facility by virtue of being a lower-middle income economy.
Covax is a work-in-progress, and is yet to raise the money it needs to pay for or subsidise the vaccines for lower-income countries. There have also been questions about whether the richer countries that are part of the facility will pay because of the deals they have already struck with vaccine-makers (the argument for is that they will do so as a way to build a vaccine stockpile in the best-case scenario and as a sort of insurance for the worst-case one). A previous instalment of this column cited an article from Nature magazine that showed that many rich countries have already struck deals with vaccine-makers to cover their entire population. The UK, for instance, has firm agreements that ensure a little more than five doses per capita; the US, two; the EU, close to two; Japan, 1.5; and Australia, one. This data is as of late August, so it is likely the numbers have increased.
WHO’s vaccine allocation plan, which has been public for some time, envisages distributing vaccine doses to cover 3% of the population of each of the participating countries and then scaling this up to 20%. Its assessment is that this will cover frontline workers in the fight against Covid, as well as the most vulnerable groups. In the second phase of distribution, WHO plans to use a risk assessment technique to understand “the potential impact of Covid-19” on a country and “the vulnerability of a country based on health systems and population factors”. The agency actually has a detailed methodology for risk assessment. There has been some criticism of WHO’s allocation protocol – the countries that need the vaccine the most should be prioritised even in Phase 1, some say. But that would have perhaps made Covax a non-starter.
Interestingly, the US National Academies of Sciences Engineering and Medicine (Nasem) put out, in early September, a document detailing a possible protocol for what it termed “equitable allocation of vaccine for the novel coronavirus”. The organisation suggests four criteria to determine the allocation: infection risk, mortality risk, “risk of negative societal impact”, and transmission risk. Based on these, Nasem came up with a four-phase plan for the allocation of the vaccine. In the first part of Phase 1, it suggests vaccinating frontline workers in the fight against Covid-19; in the second part of the first phase, it extends this to people with comorbidities as well as old people living in crowded areas. Its recommendation for the second phase includes workers in “essential” industries with high exposure risk, teachers, old people not covered in the first phase, and the homeless. In Phase 3, Nasem recommends the coverage of “young adults” and children, and also workers in “essential industries” with “increased” risk. And Phase 4 covers everyone not already covered.
India’s expert group on vaccines is working on the country’s own vaccine prioritisation protocol, and it could do worse than to look closely at the Covax allocation methodology of WHO or Nasem’s allocation framework. We need a plan for when the vaccine will be available.