For more than two decades, my organization, Gavi, the Vaccine Alliance, has been on a mission to protect the world’s poorest and most vulnerable children, vaccinating more than a billion additional children so far, and each year providing vaccines for more than half the world’s children. This has led to a 70 percent reduction in deaths from vaccine-preventable diseases. We also support stockpiles of epidemic vaccines. So when Covid-19 hit, we knew that billions of people could miss out on immunization unless immediate action was taken. That is why we help create COVAX.
During the Covid pandemic, COVAX was the only initiative that had global equitable access for high-risk groups as its main operational focus; for hundreds of millions of people most at risk in the poorest countries, this has been the only source of covid vaccines. Despite facing immense barriers every step of the way, COVAX is the main reason why 75 percent of health workers and 63 percent of older people in low-income countries are now fully protected, by the same as on average 50 percent of their populations. So if we want to have a chance of being prepared for the next pandemic, then it makes sense to have something like COVAX already in place and funded in advance, particularly before the Big One hits, to ensure that next time the response is quicker. and more effective. However, there are currently no plans for this.
It is true that global governance and financing frameworks are being developed to ensure that countries are better prepared for the next pandemic. But there must also be an operational response on hold, particularly when it comes to vaccines.
With infectious diseases, no one is safe until everyone is safe, so the role COVAX has played in ensuring that people everywhere have access to vaccines has undoubtedly been important. Given that it has delivered 1.7 billion doses and is responsible for 76 percent of the covid vaccines received by low-income countries, this begs the question of how people in these countries will access vaccines next time, to unless there is something like COVAX to secure and deliver billions of doses of vaccines?
This does not mean that we should create a new organization or institution for the pandemic. In fact, the reality is that no organization has all the knowledge, resources, or infrastructure to achieve this end-to-end approach. The only reason COVAX has been so successful is because it is based on a network approach that was able to build on the strengths of global health organizations that already existed. From its main partners, the Coalition for Innovations in Epidemic Preparedness, Gavi, the World Health Organization and UNICEF, to civil society organizations, the private sector and ministries of health, each partner turned when the crisis hit to allow COVAX as a whole to respond quickly, adapting and innovating when necessary.
All of this is necessary because carrying out vaccine rollouts on the scale we have seen with COVID, the largest and most complex global rollout in history, involves much more than just delivering vaccines. It also involves accelerating vaccine development, scaling up manufacturing so higher volumes can be produced, securing doses, negotiating lower prices, and putting in place all the logistical pieces needed to deliver vaccines, including the supply chain, cold storage, data systems, surveillance networks, and trained health workers, as well as all the important legal safety nets of indemnity, liability, and compensation.
As daunting as it sounds, the point is that we now know it’s possible, and ultimately we need to improve it. Because despite all that it has achieved, COVAX could have done better. Faced with vaccine hoarding, export restrictions and a lack of transparency from manufacturers, COVAX experienced severe supply constraints last year that caused delays. If COVAX had existed before the pandemic, rather than being created on the fly, and if contingency funds had already been at risk rather than having to be raised in the midst of a global crisis, then it could have responded faster, safer deals. with manufacturers before and shipped higher dose volumes to people faster.
We do not know what form the next pandemic will take, or whether it will be possible to develop vaccines against it. But what we do know at least is that if we don’t implement all of this now, the response will be slower and less effective. And if the next one is another Big One, it could come at a terrifying and devastating cost.