Whither COVAX? A Progress Report on the Vision of Global and Multi-stakeholder Collaboration

The fluidity in the ebb and flow of the COVID-19 pandemic continues to take us through uncharted waters as we gradually absorb the signs urging us to just “live with it” somehow.  Even the modified springtime message from the epidemiologists that we might at least manage to get past the “acute” phase of this pandemic by the end of 2021 seems to have lost its resonance. Here we are in mid-July 2021 with a global death toll passing the 4 million mark, and alarming reports about the highly contagious delta variant, the looming epsilon variant, urgent pleas  (and even mandates) from the French president and the Italian prime minister  to get vaccinated, crazy mixed messages in the UK, confusion about mask-wearing in the US, and dramatic upsurges in countries (like Indonesia this time) with low vaccination rates and limited access to available vaccine doses.  At least there is a renewed effort to work things through the COVAX Facility, both with regard to the more equitable distribution of available vaccine doses and, quite encouragingly, to increasing and diversifying the manufacturing capacity for vaccines but also for therapeutics and diagnostics. Here are my personal impressions of what this means for global and multi-stakeholder collaboration.

Media attention seemed to reflect a broadening of advocacy for a more equitable and immediate distribution of available doses in the late spring and early summer.  Editorials appeared in the NYT (US failing its moral test here) or the Washington Post (here). A good example of the heightened attention was a good overview of the issues relating to a globally equitable distribution was written by Philip Shellekens and published by the Brookings Institution in early April (available here).  The UK Prime Minister Boris Johnson made it a priority to get the members of the G7 he was hosting in C in mid-May to commit to an additional billion doses for global distribution.  (See relevant G7 documents in the parallel  bibliographic commentary available here.) Not only was this amount criticized by advocates as far too low a number, but subsequently it was criticized for not even reaching the targeted number, to say nothing about the slow timing of when they might be distributed.

The bold leadership of Kristalina Georgieva, the Managing Director of the International Monetary Fund, has been an encouraging development. Starting in early May, she embraced an IMF study and proposal  for accelerated and equitable vaccine distribution in early May. She then joined with the heads of the World Bank Group, the WHO and the WTO in a task force, with major announcements on 31 May and 30 June to support a G20 initiative to do just this. More specifically, the proposal envisioned a 40 per cent global  vaccination coverage by the end of 2021 and 60 per cent by mid-2022. It also pushed for a redistribution of available doses and an expansion of manufacturing capacity, to be financed by a $50 billion G20 commitment. Regrettably, when the G20 finance ministers and central bank governors met in Venice on 9 to 10 July 2021, merely “acknowledged the formation” of this task force!

One can be encouraged by this same G20 group having created another “high level independent panel” back in January to look at the financing (and other policy needs) for pandemic preparedness and response in the future. There is even reference to “the Global Commons” in this panel’s title. The panel’s terms of reference provided for a completed report for the Venice meeting, and sure enough its report was “welcomed” by the G20 group. The report is actually quite good – even calling for a Global Health Threats Board. But it does divert attention away from the immediate crisis. And while it was a panel of “eminent experts” from around the G20, one has to note how ingrown this array of experts might be considered by its critics to be. Of the three “co-chairs”, one was Larry Summers, the former US Treasury Secretary, and another was Ngozi Okonjo-Iweala (just before she made it through the US blocking of her appointment as head of the WTO  that was lifted by President Biden). In this setting, she was cited as a former finance minister from Nigeria. The third co-chair was Singapore’s former finance minister Tharman Shanmugaratnam. The project leader for this panel was the head of the Center for Global Development, one of whose previous chairs was Mr. Summers and one of whose previous senior fellows was Dr. Ngozi.

So where are we on global fairness today? I suppose we could cheer the COVAX Facility for getting back on its feet with at least some selective channeling of surplus doses from the US and France and elsewhere. But it’s also the case that much of the surpluses are going directly to favored countries outside of the COVAX Facility route (e.g. US doses going to Guatemala). Recent articles are documenting irritation with the COVAX Facility from Africans (e.g. the head of the African CDC) and from critical NGOS like Médecins sans Frontières and or academic institutions like the Geneva-based Global Health Centre. Some are even describing it as too much of a charitable organization and not enough of an advocate for empowering sustainable development. And then there is also the point that that the COVAX Facility is very much a product of pharmaceutical company interests that are resistant to any sharing of their vaccine know-how.

One could go on and on. It is good to see signs of support for broadening the manufacturing capacity for vaccines and of the interest in ensuring regional controls of future supplies in all of the world’s regions. I don’t see any evidence yet of a broadening of multi-stakeholder collaboration, though. And the tensions with China on the rest of the world, including the WHO  trying to learn more about the origins of the virus are deeply bothersome.  So is the accelerating spread of the delta virus, aggravated by the resistance among anti-vaxers in the US and elsewhere.  I welcome the lively debate about a vaccine passport (or whatever one might call a required vaccination certificate domestically), and I am hopeful that the efforts to increase vaccination levels everywhere will overcome the resistance – and the inaccessibility, too.

Meanwhile, I try to keep a record  of interesting pandemic-related policy proposals in a separate “commentary” (available here) without getting carried away with repeating my views about global and multi-stakeholder collaboration each time there is a new report.  All of the documents I have referred to in this commentary are available on that list. It is regularly updated, but I don’t expect too much activity in the next few weeks.  I sense that we are in the midst of the summer doldrums, with policy momentum likely to pick up in the fall – unless the unforeseen waves of the pandemic throw us off course.


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