Covax Misses its 2021 Delivery Target – What’s Gone Wrong in the Fight Against Vaccine Nationalism?

By Rory Horner, Senior Lecturer, Global Development Institute, University of Manchester. Originally published at The Conversation.

The latest supply forecast for Covax – the programme for sharing COVID-19 vaccines around the world – suggests that accelerating vaccination in low-income countries looks unlikely. Covax estimates it will have distributed 1.425 billion vaccine doses by the end of 2021, significantly less than the 2 billion doses it was aiming for earlier this year.

Only 280.5 million COVID-19 vaccine doses have been given out through Covax as of September 15 2021. With some high-income countries rolling out boosters and vaccinating children before many low-income countries have even given their adults a first dose, vaccine inequality is showing no sign of disappearing.

That Covax has fallen short on its initial forecast for 2021 is not a surprise. The CEO of the Serum Institute of India, originally the largest intended supplier to the initiative, cast doubt on the 2 billion figure soon after its release, suggesting that reaching this milestone would take an additional six months.

A major problem has been getting a good place in the vaccine queue. While Covax was raising money following its launch in June 2020, many high-income countries were already buying up much of the initial supply from manufacturers. Dr Tedros Adhanom Ghebreyesus, director-general of the World Health Organization (WHO), argues that despite providing it with financial support, the world’s biggest economies have thus undermined Covax.

However, the biggest setback was in late March, when exports of COVID-19 vaccines from India – the world’s biggest COVID-19 vaccine manufacturer – were suspended. India’s output was redirected to domestic supply in light of the country’s devastating second wave. The Serum Institute of India had been due to supply Covax with over a billion doses in 2021. Currently exports have still not resumed, with the country having exported only 20 million doses to Covax.

Low-income countries, the main target for the programme, remain drastically behind on COVID-19 vaccination as a result. On average three COVID-19 vaccine doses have been administered per 100 people in low-income countries, compared to more than 120 in high-income countries.

What Next for Low-income Countries?

In its latest forecast, Covax says it is in “ongoing dialogue with the Government of India” over COVID-19 vaccine supplies, and that “the timing and extent to which export controls in India” are released is a major cause of uncertainty. While the US government has also joined the push for India to resume exporting to Covax, the signs are not positive. A senior Indian government official was recently quoted saying that India will not resume sharing doses until all adults in the country are immunised.

Despite India making rapid progress on vaccination, with more than 780 million doses administered, only 196 million people have been double vaccinated. Full adult immunisation in India is aimed for by the end of 2021 – there are around 1 billion adultsin the country.

Covax has made other requests to donors and manufacturers, notably for countries with high vaccine coverage that are ahead of Covax in manufacturer queues to give up their places, and for enhanced donations from countries with high proportions of people already vaccinated. These requests are not new, with the head of the WHO admitting he “may sound like a broken record” in making them.

Vaccine donation pledges to date have yet to make substantial inroads into actually getting people vaccinated. In June, the G7 countries pledged to donate 1 billion doses to “poor countries”, with the UK pledging 100 million of them. Yet so far, the UK has delivered only 5.1 million doses to Covax and sent just 10.3 million abroad in total.

At the same time, the UK has actually taken doses from Covax that it has a right to (many other wealthy countries have waived their right to their share). In June, the same month it made its 100-million-dose pledge, the UK received 539,000 doses from Covax, more than double the doses Covax sent to Africa in the same month.

Boosting Inequality

To compound problems, places in the vaccine queue ahead of Covax are occupied by countries now incorporating boosters into their vaccination programmes. The UK, US and Israel have all decided to roll out additional shots – all of which, given vaccine scarcity, are much needed by Covax.

In early August, the WHO called for a moratorium on boosters until the end of September, arguing giving them would “exacerbate inequalities”. That moratorium call has recently been extended until the end of 2021. But it didn’t deter the UK from launching its booster programme.

The priorities for what the world as a whole needs are clear. Sarah Gilbert, a lead developer of the Oxford/AstraZeneca vaccine, has argued that vaccines should be distributed to countries with low rates of vaccination, given “the first dose has the most impact”. Vaccines administered to previously unvaccinated populations can save more lives than if given as boosters to already vaccinated populations. Yet national priorities continue to reign.

Mike Ryan, executive director of the WHO’s Health Emergencies Programme, has described giving booster shots as being like handing out extra life jackets to those who already have one while leaving those without to drown. The WHO’s Africa director, Matshidiso Moeti, says booster programmes “make a mockery of vaccine equity”.

The prospects of Covax accessing more vaccines are further undermined by the inclusion of children in vaccination programmes. Vaccinating 12 to 15-year-olds is scheduled to beginin the UK before the end of September. Both Gilbert and the WHO’s Mike Ryan have argued that those in low-income countries need the doses more.

The catastrophic moral failure of rich countries hoarding vaccines that Tedros warned of in January is upon us. And not only is such vaccine nationalism morally problematic, by helping the virus spread in certain parts of the world, it risks dangerous new mutations arising and may hold back global economic recovery.

Covax needs large quantities of doses as soon as possible – but those needs continue to be bypassed. Forget double-vaccinated people in high-income countries, it’s Covax that needs a booster.


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  1. Colonel Smithers

    Thank you, Jerri.

    Please forgive my stupidity, but was Covax designed to work?

    It’s a good job that the likes of Mauritius and Seychelles did not bother with that and courted the likes of Uncles Modi, Xi and Putin. Seychelles also got help from Qatar.

    Please excuse my cynicism about Gilbert, who has now licensed her image rights to the manufacturers of Barbie dolls at the suggestion of her business partner Bill Gates and who rarely mentions the poor bloody infantry / unsung heroes and heroines behind her at the Jenner institute in Oxford.

    As Gilbert rakes in the money with Gates, her colleague Sir John Gilbert has joined Blair as his advisory firm switches tack from national security to public health.

    ‘Twas ever thus with these scoundrels.

    1. Colonel Smithers

      The cynicism did not stop there. The daughters and sons in law of Captain Tom, all involved in PR, won an industry award for their PR campaign and pocketed a percentage of the money raised.

    2. Spring Texan

      Yes, Covax is a joke and a feint so they don’t have to issue a TRIPS waiver or help with manufacturing in other countries. Horrible. And working as designed. The real goal – protection of patents and profits – is being achieved.

  2. Rod

    Yes, failing so badly.
    How many here at the NC believe they could be managing it better?
    We could at least be checking the Expiration Dates with a plane on stand-by–instead of chucking them.
    Then there is this–the second of these NPR reports in the last two weeks:

    Of course no real discussion of the details of ‘How’ or even the ‘Implications’.

    This reeeaaaalllyyyy scrambled my eggs–

    SAGE KHANNA: Nobody asked, are you a citizen or not? They’re just giving you the vaccine.

    1. Rod

      The report did not indicate whether Mr Khanna offered to pay for the Service for his parents.
      The plane fare may have left him short–I don’t know.

  3. David H.

    So, can someone explain to me how India with 196 million double vaccinated out of a population of 1.366 billion survived their Delta surge?

      1. David H.

        So, doing the math of splitting the estimate and say 4.2 million died out of 1.633 billion yields your chances of dying at .26 of one percent which I believe is similar to the US.

        Again, can anyone answer my question “How did they survive?” I guess the answer is they didn’t.

        And I expect wave after wave as well.

        1. Lee

          Other factors to consider are a population’s age structure and rates of obesity. India’s median age is 28, ten years younger than the U.S., which also has an average life expectancy of ten years older (78) than in India. Also, the rate of obesity in India (3.9%) is considerably lower than that of the U.S. at a whopping 36%.

          Another factor that I can’t find out much about, probably because it is difficult to determine, is how many of us enjoy a high degree of innate disease resistance to Covid-19 and what might account for this.

  4. Hemanth Kumar

    “… the US government has also joined the push for India to resume exporting to Covax.” While millions of adults in India yet to receive first dose (let alone second dose) and India’s children yet to get anything at all, USA and Europe gave their citizens first and second doses as well as ‘booster’ doses. And have now progressed to focus on their children too.

    In view of this scenario, USA pressing India to increase its supply to COVAX appears to be cynical, to say the least.

  5. Ghost in the Machine

    If you just released the IP, I wonder how long it would take to get more manufacturing up or converted?

    1. flora

      (dons foil bonnet)

      Are Bill & Co. trying to replace the Petro-dollar with the Pharma-dollar?

      (remove foil bonnet)

  6. Merton Mac

    Too much vaguery and preaching to the choir in this article. Where are these vaccines produced, how many doses are coming out of these production sites, where are they going and how much are they costing..? This simple data would tell us more than scattergun speculation about the same gang of rich nations acting like hypocrites.

    1. Ian Perkins

      The World Health Organization’s pandemic programme plans to ship 100 million doses of the Sinovac (SVA.O) and Sinopharm COVID-19 shots by the end of next month, mostly to Africa and Asia, in its first delivery of Chinese vaccines, a WHO document shows.

      Of the 100 million Chinese vaccines, half will be provided by Sinopharm and half by Sinovac, with deliveries planned for “July to September 2021”, a WHO document dated July 29 says.

      The Chinese vaccines have been allocated to 60 countries, mostly in Africa, which is expected to receive a third of the 100 million doses.

      About 10 million Sinopharm shots had been shipped by mid-August, a spokesperson for the Global Alliance for Vaccines and Immunization (GAVI), which co-leads COVAX along with the WHO, told Reuters.

  7. Rolf

    Thank you for this post. WHO’s Mike Ryan makes some key statements in one of your links above:

    “We are pushing nature to its limit. We are pushing population to its limit. We’re pushing communities to their limits. We’re stressing the environment. We are creating the conditions in which epidemics flourish. We’re forcing and pushing people to migrate away from their homes because of climate stress.

    We’re doing so much and we’re doing it in the name of globalisation and some sense of chasing that wonderful thing that people call economic growth. In my view, that’s becoming a malignancy, not growth, because what it’s doing is driving unsustainable practices in terms of how we manage communities, how we manage development, how we manage prosperity.

    We are writing cheques that we cannot cash as a civilisation and they’re going to bounce. My fear is that our children are going to pay that price. That someday when we’re not here, our children will wake up in a world where there is a pandemic that has a much higher case fatality rate, and that could bring our civilisation to its very knees.

    We need a world that is more sustainable, where profit is not put before communities. Where the slavery to economic growth is taken out of the equation. We need sustainable growth in our communities. We need sustainable livelihoods for our people. And we’re taking huge risks – massive risks – with our future if we don’t manage the planet in which we live. And we’re being extremely irresponsible right now.”

    1. ckimball

      hi Rolf, I’d like to change the organization of the second to last sentence of Mr.Ryan’s statements. ‘And we are taking huge risks if we don’t manage’ OURSELVES to benefit the living planet in which we live.

  8. Splashoil

    Bill Gates Jr. must be proud of his ownership of WHO. Perhaps they could take a strong stand against
    Ivermectin too.

  9. Maritimer

    I think NC Editors/Moderators should know that The Conversation Canada is listed in a recent document released under an FOI request. In that doc, The Conversation Canada is listed on page one as having received $403,375 and their legal name as The Academic Journalism Society which claims to be “independent”.

    Prior to this total recent payout to favored Canadian Media of $60 million, the Trudeau Government paid out $600 million to favored Canadian Media. So, $660 million total payout.

    Some Canadians feel that this is a buyoff of Canadian Media. Media who do not get these payments are disadvantaged. There is very little media in Canada that is independent. Most of it is very, very suspect. With approximately only 10% of the US population, resources are limited to support truly alternative/investigative/independent media. There are some excellent outlets, disadvanted of course by the actions of the Canadian Government, but they do stellar work nonetheless. Possibly, NC will be linking to some of those in future. I do also realize the burden that is placed on NS Editors/Moderators. Thanks.

    1. Basil Pesto

      what is the provenance of that document? You say it is pursuant to FOI – from which government agency? There are no headings on that pdf, just a watermark for “Rebel News” which I refuse to visit on principle based on their sophomoric name alone.

      And what does this have to do with the article apart from the fact it was published at The Conversation – an Australian brand – and by an academic at a British university, no less. This is tenuous. Why should we care? What does this have to do with Canada? What are you driving at? Do you not have faith in the editors of this website to post worthwhile material because one of the crossposted publisher’s subsidiaries is funded in part by the Canadian government? If you want comments like that to be taken seriously by as many people as possible, you need to do a better job of explaining yourself.

  10. topcat

    Analysis of the official statistics in Germany show that there are no excess deaths, once you compare percentage of deaths in age cohorts and the number of people in those cohorts from year to year, and no increase in the occupancy rates of intensive care beds. In fact the reason for the percentage increase in the number of intensive care beds occupied was due to the total number of beds being reduced and not due to a higher occupancy of existing beds. This in turn was due to a change in government policy for reimbursing hospitals, requiring that they have a occupancy rate of above 75% in order to qualify for extra payments.
    In order to increase the occupancy rates the hospitals removed beds. Simple really.
    In Germany there is in fact statistically no pandemic. It would be interesting to try looking for the statistical evidence in other countries, I am going to take a look at the UK data to see what I can find.

    1. Yves Smith

      You appear to be new here. While we encourage reader participation, we are also strict about house rules.

      Making Shit Up is a violation of our written site Policies. You are not getting off on a good foot here. One more factually false comment and you will be blacklisted. I suggest you read our Policies so as to understand what is and isn’t on.

      Specifically, we expect readers to substantiate claims. Otherwise I have to waste time determining whether they are accurate or not. My energy is better spent on new posts, not clearing up disinformation.

      From our GM, via e-mail:


      Countries that did well tend to have negative excess mortality (because NPIs eliminated flu and lockdown cut traffic and workplace accidents quite dramatically)

      Germany did better than, say, the UK, and it has lower excess mortality than official COVID deaths (because of that effect), but it still has 54K excess deaths

        1. Yves Smith

          This is 2020 data and disproven by data provided by the link provided by GM, which is through three days ago.

          Germany had only 10K COVID deaths in the beginning, and that was also when the lockdown was actually somewhat serious and accordingly excess deaths were most negative.

          They moved towards letting it rip in the winter. As Ignacio added:

          Tell the guy to go to the oficial web that tracks excess mortality in Europe:

          Tell the guy to play and see what happens in Germany between 2020 week 52 and 2021 week 3. Excess mortality measured by MOMO Z-score. There was a previous episode in 2020 but not as bad as this.

          As for Sweden, the relevant comparison has always been to its similarly-situated, low-density population/high social safety net neighbors, and Sweden’s outcomes have been consistently poor.

  11. The Rev Kev

    This is really storing up trouble this. I mean how wealthier countries have thrown the poorer counties to the wolves as far as vaccines are concerned. And it may be that those countries will note which nation came to their aid in their time of need. How this will play out going forward I have no idea. I sometimes think that last year, wealthier countries could have made themselves responsible for poorer nations in helping them deal with the pandemic. So as an example, Australia & New Zealand could have made themselves responsible for helping out all the countries of the south Pacific as well as some of the larger ones. But of course that was never going to happen. A generation ago Australia, for example, would have been up for it but under the present political landscape, they would and have looked inwards instead.

  12. David Mills

    The other Vaccine Nationalism is US & EU refusal to recognize Chinese and Russian vaccines. Pity, I took Sinovac now I’ll have a hell of a time going back to Canada or France.

  13. Sound of the Suburbs

    Let’s leave it to market forces.
    When supply becomes scarce, the price goes up, and the poor can’t afford it anymore.
    That’s the way it’s supposed to work.

    That’s why rich people like market forces.
    When things get scarce, they won’t have to go without.

    1. Eustachedesaintpierre

      If there is such a thing as the invisible hand it appears to be under no restraint & is therefore due to being motivated by insatiable greed & hubris, gradually throttling us all.

      1. Sound of the Suburbs

        “Stocks have reached what looks like a permanently high plateau.” Irving Fisher 1929.
        This 1920’s neoclassical economist that believed in free markets knew this was a stable equilibrium. He became a laughing stock.
        Better shelve this for a few decades until everyone has forgotten.
        Now everyone has forgotten we can use it for globalisation.

        We forgot what happened last time.

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