The end of a large COVID vaccination effort in developing countries?

The organization that has spearheaded the global effort to bring COVID vaccines to poor and middle-income countries will decide this week whether to end that project, ending a historic attempt to reach health equity with a tacit acknowledgment that the effort fell well short of its target.

The deliberations reflect the reality that demand for COVID vaccines is declining rapidly around the world and it is almost non-existent in countries with some of the lowest coverage rates.

The program, known as COVAX, has delivered more than a billion COVID vaccines to developing countries under extremely difficult circumstances.

But it has been engulfed by the vicious vaccine nationalism of rich nations and a series of setbacks and woes that have sapped demand for vaccines.

The proposal to end COVAX will be put to a vote by the board of directors of Gavi, a non-profit organization founded in 2000 which managesto strategic reserves of emergency vaccines and provides routine childhood vaccines to developing countries.

The proposal would see COVAX “extinction” in 2023.

COVID vaccines still would be free for the 54 poor countries who traditionally receive support from Gavi for routine childhood vaccination.

However, they would be integrated into Gavi’s standard immunization schedule, primarily as booster shots for the elderly and other high-risk groups.

Another 37 countries (middle-income nations such as Bolivia, Indonesia and Egypt) would receive a one-time cash grant to “catalyze” the creation of their own independent COVID vaccination programs.

The proposal, obtained from The New York Timesit comes from Gavi’s planning committee, whose recommendations are widely adopted as presented.

The fate and performance of the global COVID vaccination program became a hot topic between Gavi donors and COVAX partners ahead of the board meeting in Geneva, a meeting that is normally an anonymous affair.

Few of the participants in the decision-making process were willing to talk about it in public.

Gavi CEO Dr. Seth Berkley said the group’s work on COVID vaccination would not be impaired if the plan were adopted.

“The plan for 2023 is to continue working to increase primary coverage as much as countries want, but also focus on helping countries cover high-risk populations,” Berkley said.

“The current proposal is to integrate the work of the COVAX into the main work of the Gavi, without closing it, but by integrating it. Because the belief is that, by the end of 2023, it should no longer be seen as an emergency program. “

There is an average primary immunization coverage of 52% in Gavi-supported countries, but in some countries the figure is still below 20%.

The World Health Organization continues to support the COVAX vaccination coverage target of 70%.

WHO, a partner of COVAX, declined to comment on the proposal being considered by the Gavi board.

Kate Elder, senior vaccine policy advisor at Médecins Sans Frontières’ Access campaign, said Gavi was moving too fast to abandon COVAX when countries have been waiting for support for years.

“They don’t have enough analysis to make this kind of policy decision,” he said.

“But this move is donor-driven. When I talk to donors, they tell me:

“We don’t want any more fundraisers for COVID-19 vaccines.” “

Weak demand for vaccines has forced COVAX to cancel and renegotiate purchasing agreements, while high-income countries, with limited interest from their own populations, continue to funnel excess supply to the organization.

Recipient countries refuse and return vaccine shipments, claiming they have more pressing health priorities.

One of the issues Gavi’s council is considering this week is to redouble efforts in catch-up campaigns for routine immunizations, rates of which have fallen sharply during the COVID pandemic.

“Most African countries would prefer to see more investment in malaria vaccines,” said a board member not authorized to speak publicly about Gavi’s activities.

Although COVID infections are on the rise in much of sub-Saharan Africa, the least vaccinated region in the world, few countries report increased hospitalization or death rates, one of the factors behind declining interest in the vaccination.

The low rates of serious illnesses and deaths reflect the fact that the region has a young population and therefore less vulnerablethat fewer people have easy access to hospital care and that causes of death are rarely determined or recorded.

All of these factors may contribute to the perception that COVID is not a pressing issue.

But coming to terms with low COVID vaccination rates around the world could allow the virus to evolve in dangerous ways, some public health experts say.

“There’s still a chance that more lethal variants could emerge, and that could be a disaster,” said Philip Schellekens, a health economist who runs the data analytics resource pandem-ic.com on pandemic inequalities between countries.

“The momentum has all but stopped in the developing world,” he added.

COVAX was severely hampered from the start.

High-income countries were quick to cut vaccine supplies while supplies were still in short supply and donations were erratic.

COVAX intended to have a supply of AstraZeneca’s vaccine manufactured by India’s Serum Institute to begin deliveries in mid-2021, but the Indian government stalled the export of 400 million doses in the face of the overwhelming surge in delta variants.

When COVAX finally had the vaccines to distribute, it became clear plans to use routine immunization systems to deliver them were inadequate, said a Gavi board member closely involved in the rollout who was not authorized to speak publicly. of the organization’s action.

Intended for adults and requiring multiple doses and extreme refrigeration, COVID vaccines posed new challenges that weak healthcare systems were unable to handle.

Frustrated by erratic supplies, some public health agencies have done little to create demand for vaccines, while a growing tide of misinformation has discouraged people from seeking them out.

When the offer was adequate, the omicron, which caused less severe disease, was the dominant variant. Motivation, especially for people who would have to travel long distances or spend their meager resources to get vaccinated, was gone.

A senior official at one of COVAX’s partner organizations, who was not authorized to speak publicly about the group’s work, said some who work with the organization refer to COVAX as a “zombie mechanism.”

Recipient countries don’t want COVID vaccines, but Gavi has to shift doses and WHO has doubled its goal to vaccinate 70 percent of the world, the official said.

“And there is interest from many of the donors who are still looking to offload their doses by donating to COVAX,” the official added.

Several senior COVAX associates described to the Times a bitter litigation that lasted for months.

They said major donors, including the Bill and Melinda Gates Foundation, Gavi had been warned that he was overexerting vaccination orders and COVID efforts, damaging his reputation due to close affiliation with COVAX failures, and straying too far from his mission.

In a statement, the Gates Foundation said it supports Gavi’s work with COVAX.

“As the pandemic unfolded and with hundreds of millions of lives still at risk, the Gavi board and other partners supporting COVAX had to make quick decisions on resource mobilization and procurement to respond to the ongoing crisis” a spokesperson for the foundation said.

“These decisions have not been easy and have involved an intense dialogue between Gavi and its partners and collaborators, including the Foundation,” added the spokesman.

COVAX had to renegotiate its contracts with four vaccine suppliers, to reduce them to between 400 and 600 million doses.

Four hundred million doses of Pfizer that came as a donation from the US government became available future options in 2023.

“We haven’t massively overpurchased,” Berkley said, adding that he expected demand from countries that are still trying to provide primary or booster doses to largely meet the doses Gavi has available.

“In a pandemic, I’d rather err on buying too many doses than erred on underdosing, especially given that countries felt there weren’t enough doses to begin with,” he said.

“If you want to get your doses early, you have to go ahead and order, even if you don’t know if they’re going to work, and that’s a risk. You have to take risks.”

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