Around the world this spring, country after country awaited their first Covid-19 vaccine shipments. They’d been promised deliveries by COVAX, the ambitious global collaboration set up to give people in rich and poor nations equitable access to the shots, but now, the vaccines were failing to arrive. In many cases, COVAX officials wouldn’t even answer the phone or respond to emails from top diplomats when asked what was happening.
Uruguay was one of those nations. Its United Nations ambassador in Geneva, Álvaro Moerzinger Pagani, said his country bought vaccines from COVAX but was unable to speak to officials at the organization. “Maybe we don’t have the contacts,” he said. Libya’s UN ambassador in Geneva said he was also shut off from those with answers. COVAX “certainly was not fair and it was not equitable,” said the diplomat, Tamim Baiou. In desperation, the governments from both countries gave up on waiting for their COVAX purchases and made their own deals with pharmaceutical companies, effectively paying twice. The systems COVAX set up, said Baiou, didn’t match “what they’re promoting to the world.”
The Bureau of Investigative Journalism and STAT reviewed confidential internal documents and spoke with officials from two dozen countries, many of whom described confusion and frustration with COVAX. Although grateful for what COVAX is trying to do, they describe struggling to get information from COVAX personnel and being left in the dark over when, if ever, deliveries would arrive.
Conceived at the start of the pandemic, COVAX had lofty goals, promising fair and equitable access to Covid-19 vaccines for every country worldwide, and giving them for free to the poorest. For richer nations, COVAX would be an insurance policy, buying vaccines from multiple manufacturers to boost the chances some of them would work. For poorer ones, it would be a lifeline.
The first 18 months have not gone as hoped. As richer countries roll out booster shots, 98% of people in low-income countries remain unvaccinated. COVAX, described as “naively ambitious” by one expert, has contributed less than 5% of the all vaccines administered globally and recently announced it would miss its 2 billion target for 2021.
Officials have received supplies months late or with little notice, throwing vaccination campaigns into chaos and sometimes delaying people’s second doses, if they got them at all. In some cases, vaccines delivered close to their expiration dates were returned or thrown away after governments were unable to distribute them in time. Countries and regions with the financial means to do so scrambled to make deals with vaccine manufacturers directly, but found themselves at the back of the line.
Many spoke only on the condition of anonymity, fearful that discussing their experiences with COVAX openly could harm their relationships with the organization.
One such ambassador from a large, developing country south of the equator described receiving an email in April telling her the next COVAX delivery wasn’t coming yet. Her heart sank. This moment, and the days that followed, were the worst situation she’d faced in her role, she said. Many thousands of free vaccines from COVAX had been given to doctors, nurses, and grandparents early in 2021, and now they wouldn’t get their second dose.
Over the next few weeks, she and her colleagues tried everything to get more vaccines. She repeatedly called her COVAX coordinator, but they wouldn’t put her in touch with the manufacturers and couldn’t tell her when more shots would arrive. She tried to contact COVAX executives directly, to no avail. Officials in her country even called their counterparts in other governments to try to negotiate deals, despite the country’s dire financial state. “We were begging for an answer,” she said.
Health officials from several nations said they expected some delays and confusion amid a global pandemic, but not to such an extent. The abrupt drop in supply this spring was largely attributed to India’s de facto ban on vaccine exports earlier this year, which blocked distribution from COVAX’s main supplier, Serum Institute of India (SII). COVAX, though, was long aware of the risks in its model. A confidential briefing by UNICEF in the summer of 2020 noted that the organization was potentially depending too highly on Indian manufacturing.
“They should have seen this coming,” said Hitesh Hurkchand, senior advisor on supply chain strategy at the World Food Program. “Where was the risk analysis?”
Critics also accuse COVAX of sidelining the organizations that represent the interests of poorer nations in its top-tier discussions, denying a voice to those most desperate.
Many of the same concerns are reflected in a review commissioned by COVAX’s umbrella organization, due to be published on Friday. A draft version of the report seen by the Bureau highlights the “insufficient inclusion and meaningful engagement” of low- and middle-income countries, civil society organizations, and community representatives; and concerns that COVAX isn’t doing enough to expand vaccine production through measures like technology transfer. It also notes that health systems will “need support” in coming months to roll out increased supplies of vaccines.
In response to the Bureau’s and STAT’s findings, COVAX said that the initiative is breaking new ground in facilitating access to Covid-19 vaccines for all, including creating the “world’s first global allocation mechanism based on principles of equity and fairness.”
It put the blame on manufacturers for the shortfall in supplies and said that its estimates of the number of doses and availability are based on information received from manufacturers. “Because of delays in the release of vaccines from manufacturers, it has not always been possible to notify countries a long time in advance” about supplies, COVAX said.
And it acknowledged that, “while the mechanism is now working at scale, volumes made available to it to date are unacceptable.” It called on manufacturers and governments “to prioritize COVAX so it can urgently accelerate deliveries to countries that need doses most.”
COVAX has delivered only 300 million vaccines so far, yet plans show that it now intends to distribute a massive 1.1 billion vaccines in the next three months. Some officials in poorer countries fear that the abrupt surge could overwhelm their health systems and lead to much-needed vaccines going to waste.
Some question whether COVAX set itself up for a fall from the start. “COVAX probably overestimated the amount of vaccines they were going to get and the speed at which they were going to get them,” said Mauricio Cárdenas, a member of the WHO’s Independent Panel for Pandemic Preparedness and Response. “And they basically told that story to the countries.”
A year and a half since COVAX launched, the vision it presented to the world has failed to materialize. Many countries in the global south are experiencing wave after wave of Covid-19 with the vast majority of their populations still unvaccinated.
“We were begging for an answer.”
Ambassador from a large, developing country south of the equator
In January 2020, at a bar in the Swiss mountain resort of Davos, Seth Berkley and Richard Hatchett were discussing the growing crisis in Wuhan, China. Berkley is CEO of Gavi, The Vaccine Alliance, a public-private partnership that improves access to vaccines for poor countries. Hatchett is head of the Coalition for Epidemic Preparedness Innovations (CEPI), a foundation that finances the development of vaccines to stop epidemics.
CEPI had already made its first deals to finance three Covid-19 vaccine candidates for early human clinical trials, anticipating a global emergency.
After witnessing the White House’s response to the 2009 swine flu epidemic, when vaccine supplies were snatched up by wealthy nations, Hatchett knew a similar reaction to Covid-19 would mean disaster for much of the world. To avoid that, he told Berkley, they needed to “try to create a globally inclusive system that serves everyone’s needs.”
A month later, Hatchett shared a proposal for the initiative that would become COVAX. It would be an end-to-end program — spanning vaccine development to delivery — for every…