Infectious diseases do not respect borders.
An estimated 3 billion people in low-income countries
across Africa, Asia and Latin America are likely to lack
access to a COVID-19 vaccine for years after it becomes
available. In poor nations, many communities lack the
health care workers needed to administer vaccines, as
well as the capacity to handle vaccines properly by
keeping them extremely cold.
As a bioethicist studying global access to essential
medicines, I’m closely monitoring what wealthy countries,
foundations and international organizations are doing
about this problem.
The COVID-19 Vaccines Global Access Facility, or
COVAX, is a joint effort by 184 countries working with
international organizations to make it possible for people
everywhere to get affordable access to COVID-19
vaccines as they become available.
So far, COVAX has raised about US$1.8 billion toward an
initial target of $2 billion to cover the cost of manufacturing
and distributing COVID-19 vaccines around the world.
The goal of this initiative is to produce 2 billion doses by
the end of 2021. However, many of the rich countries
taking part are striking their own deals apart from COVAX
to assure that they will get early access to a vaccine.
These instances of “vaccine nationalism” threaten to
undermine COVAX and other attempts to equitably
distribute new COVID-19 vaccines and treatments.
Several large industrialized countries – including the U.S.
and Russia – have opted to stay out of the agreement
altogether. They are making their own arrangements with
pharmaceutical companies instead.
Distributing COVID-19 vaccines could prove as hard as or
harder than coming up with the money to pay for them.
That’s because the most promising vaccines require
constant and extremely cold storage. Especially in areas
where access to electricity is unreliable or missing
altogether, there simply are not enough health facilities
with the required refrigeration capacity.
Nearly 3 billion people around the world live in places
lacking the temperature-controlled storage needed for a
wide-scale immunization campaign. How bad this problem
turns out to be will depend on which vaccines are
ultimately approved, because not every vaccine
undergoing clinical trials requires storage at the same cold
What’s more, there are not enough health workers to
administer the vaccines, and it’s extremely hard for many
people in poor communities to travel to health clinics.
The United Nations Children’s Fund, a U.N. agency that
provides aid to children worldwide, is leading the COVAX
initiative’s vaccine distribution plans. UNICEF has worked
with the public-private partnership called GAVI, formerly
Global Alliance for Vaccines and Immunizations, in the
past to supply developing countries with the specialized
refrigeration technology needed to keep vaccines ice-cold.
In addition, UNICEF aims to stockpile 520 million syringes
by the end of 2020, up to 1 billion syringes by 2021 and 5
million safety disposal boxes.
International organizations and foundations
Several other international organizations are also working
to make sure that people in low-income countries will have
access to a COVID-19 vaccine and to treatments as well.
As of October 2020, the World Bank planned to provide
US$12 billion to finance vaccine acquisition and
deployment in low- and middle-income countries like India
Other regional development banks are also playing an
important role, since COVAX will not provide enough
vaccines for everyone in the world. For instance, in subSaharan Africa, only 28% of health care facilities have
access to reliable electricity, so the African Export-Import
Bank has $3 million in grant funding to help communities
procure equipment and supplies. Moreover, the bank is
talking with the Africa Centres for Disease Control and
Prevention about allocating $5 billion to buy COVID-19
And the Global Fund has allocated $665 million of the
estimated $20 billion needed to vaccinate everyone in the
whole world. Their COVID-19 Response Mechanism will
improve supply chains for vaccine distribution and health
systems in general.
Other organizations with extensive experience in
vaccination campaigns are also stepping up to help.
For example, the Global Polio Eradication Initiative is
providing staff trained to do polio surveillance to test
wastewater for COVID-19, distribute masks and hand
sanitizer, and perform contact tracing. When a vaccine
becomes available, this polio group will likely help out as
Foundations, especially the Bill & Melinda Gates
Foundation, are also playing a role.
The Gates Foundation is teaming up with GAVI and the
Serum Institute of India to speed up COVID-19 vaccine
The vaccines will be sold for no more than $3 a dose to 92
low- and middle-income countries including Brazil, Chile,
Singapore and South Africa.
In 1999, the Gates Foundation pledged $750 million to
launch GAVI, and it has given $4 billion to the
organization to date. At the 2020 Global Vaccine Summit,
a virtual meeting hosted by the U.K., the Gates
Foundation promised to spend $1.6 billion to vaccinate
300 million children against several diseases, including
COVID-19 once vaccines become available.
The Gates Foundation is also participating in a joint effort
with the World Health Organization and several other
international organizations to pay for 100 million antigen
rapid diagnostic tests being made available in low- and
middle-income countries – where they are priced at $5 or
Likewise, many other philanthropic efforts are underway in
conjunction with companies and international agencies.
The Wellcome Trust, for example, in partnership with the
Gates Foundation and Mastercard, has funded the
COVID-19 Therapeutic Accelerator a research alliance to
develop new COVID-19 treatments and tests.
In my view, these efforts are just as important as efforts to
develop, manufacture, and distribute new vaccines. After
all, if no safe and effective vaccine emerges, testing,
tracing, personal protective equipment and treatments will
remain essential for combating the pandemic and saving
millions of lives around the world