![]() We analyze UNICEF’s publicly available data on global dose donation in 2021 (see methods section below) and show that donating countries and vaccine manufacturers have broken the principles COVAX set for maximizing the impact of vaccine donations. This article nuances this narrative by analyzing the political interests and diplomatic struggles that have curbed the effectiveness of COVAX’s dose-sharing scheme and limited COVAX’s ability to correct the inequitable global distribution of vaccines: by the end of 2021 only 8.5% of people in low-income countries had received at least one vaccine dose, versus 76–78% in high and upper-middle -income countries. By capitalizing on a long tradition of framing global health as “evidence-based” and guided by scientific rationality, COVAX’s multilateral dose-sharing mechanism was presented as the antithesis of “vaccine nationalism” (that is, unilateral vaccine policies driven by national health security interests) and “vaccine diplomacy” through bilateral donations (deemed to be driven by foreign policy interests). COVAX established itself as the go-to global hub for sharing doses “equitably, effectively and transparently,” one that was to be implemented by experts, controlled by independent scientists, guided by ethical principles, and designed to be cost-effective. Throughout 2021, COVAX, wealthy governments, and the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) all promoted vaccine donation as a key solution to what the WHO’s Director General has dubbed a “vaccine apartheid”. His message has been buttressed by dozens of press releases and accompanying social media posts displaying images of smiling donor and recipient delegations alongside branded vaccine shipments and statements from COVAX and donor country leaders mutually praising each other for their shared contributions towards global Covid-19 vaccine equity. In September 2021, the CEO of Gavi, which co-leads the global vaccine initiative COVAX, said that “sharing doses with COVAX now represents the single most effective intervention a country can make in terms of halting the circulation of the virus”. The lack of transparency and accountability mechanisms within COVAX’s overly complex governance structure as a global public-private partnership enabled these practices. Although dose-sharing helped COVAX’s vaccine delivery, its impact was undermined by donors’ and industry’s pursuit of national security, diplomatic and commercial interests, which COVAX largely accommodated. ConclusionsĬOVAX’s pivot from global vaccine procurement mechanism to dose-sharing hub can be seen as a “win-win-win” solution for COVAX itself (who could claim success by having access to more doses), for donor countries (who could rebrand themselves as charitable donors rather than “vaccine hoarders”), and for the pharmaceutical industry (maintaining the status quo on intellectual property rights and protecting their commercial interests). Some donors even earmarked doses for specific recipients, complicating and potentially undermining COVAX’s equitable allocation mechanism. Donor countries and vaccine manufacturers systematically broke COVAX’s principles for maximizing the impact of dose-sharing, delivering doses late, in smaller quantities than promised, and in ad hoc ways that made roll-out in recipient countries difficult. However, donations could not compensate fully for COVAX’s persistent procurement struggles: it delivered less than half of the two billion doses it originally projected for 2021, a fraction of the 9.25 billion doses that were administered globally in 2021. ![]() Resultsĭonated doses were an important source of COVAX’s vaccine supply in 2021, accounting for 60% of the doses the initiative delivered (543 million out of 910 million). This article provides a critical analysis of the principles and practice of “dose-sharing,” showing how it reveals the politics at play within COVAX. COVAX positioned itself as a global vaccine-sharing hub that promised to share doses “equitably, effectively and transparently,” according to rational criteria overseen by independent scientists. In 2021, donor countries, the pharmaceutical industry, and the COVAX initiative promoted vaccine donation or “dose-sharing” as a main solution to the inequitable global distribution of Covid-19 vaccines.
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