Covax, the multilateral mechanism for global access to Covid-19 vaccines, will wind down by December 31. The facility has supplied nearly 2 billion Covid-19 vaccine doses and safe injection devices to 146 economies, the World Health Organization said.

Launched in 2020, the facility was jointly led by the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, the Vaccine Alliance (Gavi), UNICEF and the WHO. Indian vaccine maker Serum Institute and syringe-maker Hindustan Syringes & Medical Devices, for example, supplied Covid-19 vaccines and auto-disable syringes, respectively to Covax.

“Its (Covax) efforts are estimated to have helped avert the deaths of at least 2.7 million people in the Covax Advance Market Commitment (AMC) low- and lower middle-income participating economies (lower-income economies) that received free doses through the mechanism, alongside nearly $ 2 billion in critical support to turn vaccines into vaccinations,” the UN health agency said.

These 92 lower-income economies eligible to participate in the programme with support from the financing mechanism – Gavi -COVAX AMC, will continue to have the option to receive Covid-19 vaccine doses and delivery support through Gavi’s regular programmes, the note said. “So far, 58 lower-income economies have requested a total of 83 million doses in 2024, with plans to focus on the continued protection of priority groups, including health care workers, community workers and older adults.”

With collaboration from manufacturers, all of Covax’s advance purchase supply agreements have been completed or terminated by the end of 2023, except one, where a modest volume of supply will continue into the first half of 2024 in support of the new Covid-19 routine immunisation programme.

The Covax wind-down comes even as the WHO designated the JN.1 as a separate “variant of interest” from the BA.2.86 lineage due to the spike in cases across the world.

The inequitable access to Covid-19 vaccines has been a major criticism and take-away from the public health exercise.

Vaccine access

“While Covax was unable to completely overcome the tragic vaccine inequity that characterised the global response, it made a significant contribution to alleviating the suffering caused by Covid-19 in the Global South.,” the WHO said.

Covax also deployed 2.5 million doses to protect the most vulnerable in humanitarian and conflict settings through a first-of-its-kind mechanism called the Humanitarian Buffer, co-designed with international humanitarian organisations and set up as a last resort to reach those who are not easily reached through government programmes, it added.

Lessons drawn

Outlining challenges, it said, “Without having any cash reserves up front, it (Covax) was initially limited in its ability to sign early contracts with manufacturers, and while it was able to ship doses to 100 economies in the first six weeks of global roll-out, export bans and other factors meant that large-volume deliveries were only received in the third quarter of 2021.”

Partnering agencies had drawn on lessons from the H1N1 pandemic when the majority of countries missed out on vaccines, the WHO said. Covax partners advocated from the earliest stages of the Covid-19 emergency that “no one is safe until everyone is safe”.

By end-2020, 190 economies of all income levels had signed agreements with Covax, making it one of the most significant multilateral partnerships of the 21st century, the WHO said. By November 2020, it raised $ 2 billion towards vaccine procurement, and in January 2021, 39 days after the first vaccine administration in a high-income country, the first Covax-supplied doses were administered in a lower-income country.

Meanwhile, some of its learnings for the future included strengthening existing capacity “by designing, investing in and implementing an end-to-end solution to equitable access ahead of time, one that centres on the needs of the most vulnerable; recognising that vaccine nationalism will persist in future pandemics and putting in place mechanisms to mitigate it – including by diversifying vaccine manufacturing so all regions have access to supply; and accepting the need to take financial risks to avoid potentially deadly delays to the development, procurement and delivery of medical countermeasures,” the note said.

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