Redistributing surplus COVID 19 vaccine doses

What is COVAX? How does it work?
02 March 2021

Interview with 

Robin Cohen, Oxford University




The UK Covid vaccine programme is well under way. But as we’ve heard a few times on this show, the SARS-COV2 virus presents a danger until the whole world has been vaccinated. This week, Ghana received its first 600,000 doses of the Oxford/AstraZeneca vaccine. Following India, it is the second country to receive covid vaccines distributed by the scheme COVAX - an organisation working to ensure fair distribution of covid vaccines around the world. Robin Cohen is professor of development studies at the University of Oxford. Katie started by asking Robin about COVAX...

Robin - Well, it was set up primarily by the World Health Organisation. France was also very involved in its initial foundation. And the idea was initially to create a big purchasing block that would be able to negotiate with the big pharmas [pharmaceutical companies] in the case of the companies that are trying to make money out of the vaccines, and with AstraZeneca, who I think as everybody knows is doing it more or less on a freebie basis, or an at cost basis. And the idea was that COVAX would create buying power that would allow a lot of poorer countries and middle income countries access to these vaccines at scale.

Katie - How's it going?

Robin - Well, it's not too bad. Of course, there are two aspects of it. One is that you need the funding to buy the vaccines in the first place. And a number of countries have come to the party in that respect. It's basically [the] World Health Organisation that is brokering COVAX and creating the institutional framework under which it works. So quite a few countries have come, including the UK, to add their money to the COVAX pot. So they bought quite a few vaccines. Not of course, as many as they need. At the moment, they've got roughly about 20 to 30% of the vaccines that they would need to vaccinate a big proportion of the world.

Katie - You've written about richer countries ordering more vaccine doses than are actually needed to immunise their populations. Why is this happening? And what scale are we talking about?

Robin - Well, the scale is really quite enormous. Now let me start by saying, although there are lots of people who've made indignant moral comments about this and said, "why on earth do people need this? Is this a form of vaccine gluttony?". My own view is that basically there was no way in which the procurement agencies could really determine which of the vaccines were safe and effective and gain regulatory approval. So this is not as it were a moral argument at first, but now it is becoming so because it's becoming clearer and clearer that there are many more vaccinations available to rich countries than they could ever possibly use. So just to give you an idea of the magnitude of what we're talking about, if we take collectively Canada, Australia, New Zealand, the EU, the UK, and the US, and put them all together in one bundle, it's well in excess of 1 billion surplus vaccinations, I mean, full vaccinations. So as it were two where two are necessary. So that's an awful lot of vaccinations that are going begging in the medium term. And what we now need to do is ensure that this redistribution is possible, probably through the agency of COVAX.

Katie - Is there another factor to bear in mind here, which is if countries need more than previously thought, for instance, if say someone makes an immune response to the viral vector in a vaccine and therefore dose two can't necessarily be the same type as dose one. Is that something that's important to consider?

Robin - That definitely is important to consider. There are all kinds of issues. There are also production delays, this has been experienced by AstraZeneca in Europe, as we know in mainland Europe. So there are all kinds of contingencies here. But if you take pretty well everything in the round, how many are spoiled, how many might be needed to cover additional variants and so on, there is undoubtedly a very large number remaining that need to be redistributed. And we need to create the mechanisms whereby this happens equitably and fairly.

Katie - What are the logistics of redistributing these vaccines to places that need them?

Robin - Well at the moment, the basic idea is that the countries that are definitely not going to use what they've ordered would be able to divert through donation or through sale. And I suppose there are all kinds of other political issues then come in - do you try to use vaccines to influence your foreign policy outcomes? And we've noticed this happening, particularly in the case of China and Russia, but also in some other cases. So we might, for example, look at the current discussions between the US and Mexico, where the Mexican president is suggesting that the US should send surplus doses to Mexico precisely at the time where they are complex trade negotiations between Canada, the US and Mexico occurring. So there's a very, very complex political structure around the issue of redistribution.

Katie - Would all of the vaccines be suitable for this? Do you think?

Robin - Well, of course it's been argued that not every vaccine can be redistributed because certain of them need a good cold chain. But with a little bit of imagination, it is possible certainly to use all vaccines in most countries. For example, one can create cold, cool ports in airports, international airports in places like Johannesburg or Cape town or Rio de Janeiro, Sao Paolo and redistribute even cool chain, cold chain vaccines at that point.


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