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What is COVAX?

February 5, 2021 by Hannah Kettler

Five key questions and answers on the global initiative to deliver COVID-19 vaccines to billions of people.

A COVID-19 testing center in Madagascar. Photo: World Bank / Henitsoa Rafalia.

A COVID-19 testing center in Madagascar, where the pandemic has exacerbated hunger and economic instability. Madagascar is one of 92 countries that will be supported by the COVAX Advance Market Commitment. Photo: World Bank / Henitsoa Rafalia.

The COVID-19 pandemic ushered in unprecedented challenges for people and governments around the world. But the global community has responded in kind with COVAX—a collaborative, global initiative unlike any other.

What is COVAX?

In responding to a pandemic like this one, speed is everything. We need to develop vaccines, scale up manufacturing capacity, and deliver vaccines around the world as quickly as possible.

The Access to COVID-19 Tools (ACT) Accelerator is a global public-private-philanthropic collaboration to accelerate the development, production, and equitable rollout of COVID-19 tests, treatments, and vaccines. COVAX is the vaccines pillar of the ACT Accelerator.

COVAX brings together experts from around the world to collaborate on the research and development of a wide range of COVID-19 vaccine candidates and the manufacturing, procurement, and delivery of the vaccines once approved.

Through a mechanism known as the COVAX Facility, the partnership aims to secure and equitably allocate 2 billion doses of COVID-19 vaccines by the end of 2021. The vaccines are targeted for World Health Organization (WHO)-defined priority populations, including frontline health care workers and other groups at high risk.

Who is involved?

Gavi, the Vaccine Alliance (Gavi), the Coalition for Epidemic Preparedness Innovations, and WHO co-lead COVAX. Gavi coordinates the COVAX Facility.

These organizations are global nonprofit and multilateral leaders in vaccine development and distribution, but they can’t do it alone. Success depends upon governments joining and vaccine manufacturers agreeing to make vaccines available.

So far, 190 countries (soon to be 191, once the United States formally joins) are participating in the COVAX Facility. This includes most of the 92 countries that are eligible for donor-funded doses through the COVAX Advance Market Commitment (AMC)—an innovative financing mechanism through which the world’s poorest countries will gain access to COVID-19 vaccines.

The ability to gain timely, equitably access to vaccines is clearly beneficial for lower-income countries. The benefit to higher-income countries is the protection that COVAX can provide by investing in a broad portfolio of vaccines as well as competitive prices.

At PATH, we’re contributing toward and complementing COVAX by mobilizing our staff, networks, and partnerships to anticipate and address country needs. Through our expertise in vaccine financing, procurement, and partnerships, we’re assisting the COVAX Facility with program design and operationalization. And with our manufacturing expertise, we’re helping evaluate production capacity and offering strategies for scale-up. We’re also providing technical assistance to support COVID-19 vaccine trial-site readiness in Africa and Asia.

Why do we need COVAX?

The race to produce vaccines for billions of people at once is uncharted territory. And with a disease like COVID-19, it’s critical to ensure broad coverage and equitable access.

Equitable vaccine distribution isn't just ethical—it’s essential for controlling the spread. COVID-19 doesn’t respect borders, and its variants are adding additional urgency and uncertainty. No one is safe until everyone is safe.

Developing a vaccine requires that the best minds work together. A number of vaccines have been approved for emergency use by national governments and have or are in the process of securing WHO approval, which will allow for broader distribution.

Even as these COVID-19 vaccines begin to roll out, demand still far outpaces supply by billions of doses, and most countries have yet to obtain any. More vaccine candidates are in development across the globe, and COVAX is working to quickly narrow the gap between the time of first introductions and global allocation.

Equitable vaccine distribution isn’t just ethical—it’s essential for controlling the spread.

Collaboration reduces risk for everyone involved. Vaccine research and development is expensive, and the risk of failure is high, even for higher-income countries. By investing in a diverse portfolio of vaccine candidates, COVAX can hedge risk on behalf of all members.

How does the COVAX Facility work?

Governments and philanthropists have provided vaccine developers with significant funding to support and help mitigate the risks of product development. But what about incentives to scale up manufacturing to meet global demand, including for the poorest economies?

To address this, the COVAX Facility is negotiating advance deals across a broad portfolio of COVID-19 vaccines, including offering pre-payments to increase manufacturing capacity. The facility depends on its ability to bring both self-financing participant resources (from higher-income countries) and donor funding (through the AMC) to the table, to create enough demand to secure its share of early doses. In essence, the facility must have sufficient buying power to compete with countries independently seeking bilateral deals with manufacturers.

COVAX exceeded its initial US$2 billion fundraising target for the AMC and is now making progress toward its US$5 billion goal for 2021. These funds will pay for early doses for the 92 most resource-limited economies. The facility is also working to coordinate and collaborate with other donors and funders, such as the World Bank, that have made money available to countries to support vaccine introduction and delivery in these locations.

How is COVAX helping countries prepare for COVID-19 vaccine delivery?

The world may not have been ready for COVID-19, but we can be ready for vaccine delivery. Anticipating and mapping out a vaccine’s full journey, from lab to patient, will help ensure success.

The world may not have been ready for COVID-19, but we can be ready for vaccine delivery.

In short, COVAX’s success hinges on country readiness to deliver COVID-19 vaccines, including putting legal and regulatory policies in place. Investments in infrastructure and workforce must be scaled up quickly, from cold chain expansion and health care staffing to identifying delivery routes and designing effective packaging. Policy and community engagement strategies should also be happening now. This includes identifying target populations and raising awareness and acceptance in communities that might be wary of a new vaccine.

To boost these efforts, COVAX is providing essential resources for technical assistance and cold chain expansion to AMC-eligible countries.

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