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The global scheme to deliver Covid-19 vaccines to the poorest countries faces a “very high” risk of failure, which could leave billions of people without access to vaccines until 2024, according to internal documents.
The Covax scheme has been plagued by a number of problems, including a shortage of approved vaccine doses and a decision by the Serum Institute of India, which was initially intended to supply Covax, saying it would prioritize supplying India first.
The cheapest and easiest-to-transport vaccines the scheme has bet on, including the University of Oxford’s AstraZeneca vaccine, have been slower in testing and regulatory approval.
The grim warning is contained in a financial risk assessment commissioned by Gavi, an alliance of governments, pharmaceutical companies, charities and international organizations that organizes global vaccination campaigns and is the WHO partner in the Covax scheme.
To meet its goal of vaccinating at least 20% of people in poor countries next year, Covax says it needs $ 4.9 billion in addition to the $ 2.1 billion it has already raised.
This assessment is not shared by the insiders of the World Health Organization, which represents one of the three pillars of the Covax scheme, who point out that negotiations with pharmaceutical companies have not adhered to the scheme so far, as well as with individual countries overdoses are still ongoing, and further announcements on the plan are expected shortly.
The Covax program is the world’s leading scheme to vaccinate people in poor and middle-income countries against the coronavirus.
Its goal is to deliver at least 2 billion doses of vaccines by the end of 2021 to cover the 20% of the most vulnerable people in 91 countries, mainly in Africa, Asia and Latin America.
But in internal documents leaked to Reuters, Gavi says the program is struggling with underfunding, supply risks and complex contractual arrangements, which could make it impossible to achieve its goals.
“The risk that a successful Covax installation cannot be established is very high,” reads an internal report to Gavi’s board of directors.
The report and other documents prepared by Gavi will be discussed at board meetings December 15-17.
The facility’s failure could leave some people without access to vaccines until 2024, says one of the documents.
The risk of failure is higher because the scheme was established very quickly, operating in “uncharted territory,” the report says. It also warns that problems with contracts that allow countries to back out of purchasing doses to which they have committed could drive the cost of doses up from the $ 5.20 benchmark and ultimately cause the scheme is no longer viable.
“Current exposure to risk is considered out of risk appetite until there is complete clarity on the size of the risks and the possibilities to mitigate them. Therefore, intensive mitigation efforts are required to bring risk into risk appetite. “
While some pharmaceutical companies working on vaccines, including AstraZeneca, have signed up to provide the vaccine at cost, other potential producers have not yet signed up with Covax. Richer countries, which have often invested in vaccine development, have reserved many of the first batches of vaccines in advance.
Covax’s plans are based on cheaper vaccines that have yet to receive approval, rather than vaccines from pioneers Pfizer / BioNTech and Moderna that use newer more expensive mRNA technology.
The Pfizer vaccine has already been approved for emergency use in several countries and deployed in Britain and the United States, and the Moderna vaccine is expected to be similarly approved soon.
So far, Covax has reached non-binding supply agreements with AstraZeneca, Novavax and Sanofi for doses of 400 million, with options to order several hundred million additional injections, says one of the Gavi documents.
But all three companies have faced delays in their trials that could delay some potential regulatory approvals until the second half of 2021 or later.
Gavi hired Citigroup last month to advise on how to mitigate financial risks. The issue of the complexity of contracts for vaccines has been around for some time, and experts are concerned about a lack of transparency about the precise arrangements for the supply of vaccines and the timing.
When asked about the documents, a Gavi spokesman said the agency remains confident that it can achieve its goals.
“It would be irresponsible not to assess the risks inherent in such a massive and complex company, and to build policies and instruments to mitigate those risks,” he added.
Citibank said in a statement: “As a financial advisor, we are responsible for helping Gavi plan for a variety of scenarios related to the Covax facility and support its efforts to mitigate potential risks.”
On Tuesday, a senior WHO official said the agency was in talks with Pfizer and Moderna to list their Covid-19 vaccines as part of an early global launch at a cost to poor countries possibly lower than current market prices. for almost $ 20 a dose.
Other injections are in development around the world and Covax wants to expand its portfolio to include vaccines from other companies.
Reuters contributed to this report.
