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Analysis: Why Covax, the best hope for vaccinating the world, was doomed to fall short

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Analysis: Why Covax, the best hope for vaccinating the world, was doomed to fall short

It was, many experts thought, a noble and necessary effort.

The goal: to combat a deadly coronavirus that in early 2020 was already spreading around the world.

The idea: to coax wealthy and poor countries to pool their money to place advance orders for vaccine doses. Participating countries would then share doses equitably to protect their most vulnerable people first.

But just months into the effort, it should have been clear it was doomed to fall short.

The initiative’s backers badly misjudged the desperation and myopia of wealthier countries, which raced to manufacturers to snatch up doses for their own people. Covax — as the program became known — was also too slow to adapt its model even as countries declined to participate and infections and deaths soared, according to more than two dozen international health officials, diplomats and other top experts. ...

Two years into the pandemic, the world has seen more than 470 million confirmed covid-19 cases and at least 6 million deaths. Many wealthy nations are trying to move on, preoccupied with the Russian invasion of Ukraine or domestic economic problems such as inflation. Efforts to prepare for the next pandemic have faltered.

But just two months after the omicron variant led to an enormous global wave of coronavirus cases, case numbers have again risen sharply in East Asia and Western Europe.

Unlike many national governments, those behind Covax saw the risk presented by the coronavirus early. But the initiative has fallen well short of its aims. More than a third of the world is yet to have a vaccine dose. That has left a huge gap between rich and poor countries. Experts say the lack of vaccinations in poor countries is not only inequitable but also dangerous, exposing the world to a greater likelihood that more-virulent variants will emerge.

And the challenges for Covax continue. Covax has raised $11 billion in total, well short of the $18 billion it initially said it needs. Falling short of funding targets for the spring could cost 1.25 million lives, backers say.

“We are right now basically out of money,” said Seth Berkley, head of the Vaccine Alliance, or Gavi, one of the main organizations behind Covax, during a fundraising call in January.

The takeaway: The world cannot count on mere goodwill and cooperation to propel responsible public health measures in the future.

“They are right to say that the [Covax] model would work — if we were organized differently as a world,” said Andrea Taylor, a researcher at the Duke Global Health Institute. “It clearly didn’t work and doesn’t work in the world in which we do live.” ...

In the early months, the alliance came together swiftly with the support of the World Health Organization. But it was missing what had proved instrumental in fighting other global scourges — leadership from a powerful country.

The United States played that role in the effort to control HIV/AIDS in Africa. The George W. Bush administration spearheaded the President’s Emergency Plan for AIDS Relief, or PEPFAR, which devoted billions of dollars to fight HIV/AIDS on the continent.

The success of PEPFAR “was driven by leadership at the head of state level, which is absolutely essential,” said Mark Dybul, who helped create the initiative.

Hatchett said the idea of an equivalent effort to fight covid met with “no receptivity from the Trump administration,” which eventually pulled funding from the WHO and opposed Covax. No other wealthy country stepped in to fill the void.

Covax’s missteps also hobbled the effort. A report by Doctors Without Borders found that the alliance held key early meetings that excluded officials from the developing world, but included McKinsey & Co., a U.S. consulting firm with close ties to pharmaceutical companies.

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