On Monday, the World Health Organization (WHO) announced that 64 wealthy countries have joined its Covax facility for the fair distribution and allocation of a Covid-19 vaccine. This author has previously referred to Covax, an association of vaccine developers and countries established by Gavi, the Vaccine Alliance, the Coalition of Epidemic Preparedness Innovations (Cepi) and the WHO, which aims to source and distribute two thousand million doses of the vaccine by the end of 2021. An additional 38 countries are expected to join Covax in the coming days, the WHO said. Currently (including 64), 156 countries are part of the facility under which they will receive the vaccines, with 92 eligible for free or subsidized vaccines. However, rich countries will pay for the vaccine; their participation is, in effect, a protection to ensure that they have access to a successful vaccine (although many of them have already signed agreements with vaccine manufacturers for hundreds of millions of doses). The WHO said Monday that its alliance now covers 64% of the world’s population. Interestingly, neither China nor the US (the third and third most populous nation in the world) are part of the installation. India is part of the facility by virtue of being a lower middle income economy.
Covax is a work in progress and has yet to raise the money it needs to pay for or subsidize vaccines for low-income countries. There have also been doubts as to whether the richer countries that are part of the facility will pay due to the agreements they have already reached with vaccine manufacturers (the argument in favor is that they will do so as a way to accumulate a reserve of vaccines in the country). at best and as a kind of insurance for the worst). An earlier installment of this column cited an article in the journal Nature that showed that many rich countries have already reached agreements with vaccine manufacturers to cover their entire population. The UK, for example, has firm agreements guaranteeing just over five doses per capita; United States, two; the EU, about two; Japan, 1.5; and Australia, one. These data are from the end of August, so the numbers are likely to have increased.
The WHO vaccine allocation plan, which has been public for some time, plans to distribute vaccine doses to cover 3% of the population in each of the participating countries and then scale them up to 20%. His assessment is that this will cover frontline workers in the fight against Covid, as well as the most vulnerable groups. In the second distribution phase, WHO plans to use a risk assessment technique to understand “the potential impact of Covid-19” in a country and “the vulnerability of a country based on health systems and population factors.” In fact, the agency has a detailed methodology for risk assessment. There has been some criticism of the WHO allocation protocol: Countries that need the vaccine the most should have priority even in Phase 1, some say. But that might have made Covax a non-starter.
Interestingly, the US National Academies of Sciences, Engineering and Medicine (Nasem) published, in early September, a document detailing a possible protocol for what it called “equitable allocation of the vaccine for the novel coronavirus.” The organization suggests four criteria to determine the assignment: risk of infection, risk of mortality, “risk of negative social impact” and risk of transmission. On this basis, Nasem developed a four-phase plan for vaccine allocation. In the first part of Phase 1, it suggests vaccinating front-line workers in the fight against Covid-19; In the second part of the first phase, it is extended to both people with comorbidities and older people living in crowded areas. Their recommendation for the second phase includes workers in “essential” industries with high risk of exposure, teachers, the elderly not covered in the first phase, and the homeless. In Phase 3, Nasem recommends coverage for “young adults” and children, and also workers in “essential industries” with “increased” risk. And Phase 4 covers everyone who isn’t covered yet.
India’s expert group on vaccines is working on the country’s own vaccine prioritization protocol, and it could be worse than looking closely at the WHO’s Covax allocation methodology or Nasem’s allocation framework. We need a plan for when the vaccine will be available.
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