By Alexander Smith
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COVAX’s initial vision was that everyone would use the program to buy vaccines: Rich nations would donate cash to ramp up research and manufacturing, and rich and poor nations would divvy up shots fairly at the end.
“It was perhaps overly idealistic and ambitious,” said Charles Clift, a former WHO and British government official specializing in getting medicines to developing countries.
In reality, COVAX had to settle for a messy, hybrid system. Rich countries still donated money. But they had already started striking their own bilateral side deals with drugmakers. Essentially COVAX found itself competing against its own most powerful donors. It was never a fair fight.
“It was very clear that the win-win option was a global solution,” WHO Assistant Secretary-General Dr. Bruce Aylward told NBC News. “But national interests played a big part in the decisions going other ways.”
Compare COVAX’s dizzying challenges with the America-first approach of the Trump administration, the effects of which still linger.
Before the first Covid-19 death on American soil in February, Trump’s Operation Warp Speed program was striking deals with pharmaceutical companies. It pumped $12 billion into research and domestic manufacturing, taking huge risks in the hope one vaccine candidate would work.
This investment came with strings attached: The U.S. expected to be served first.
Later in the year, the White House worked hand-in-glove with the Food and Drug Administration to approve these vaccines faster than almost anywhere else.
Given the political pressures, “vaccine nationalism is at the same time ethically indefensible and probably politically inevitable,” said Justine Landegger, a senior vaccine consultant at Resolve to Save Lives, which is working with African countries to prepare for their rollouts.
By contrast, COVAX took months to raise enough cash to enter negotiations with drugmakers. And even then, it had to act as a go-between for dozens of nations, always keeping one eye on value for money.
It was essentially saying: “‘I understand that you can sell these vaccines for three times their price, but I actually want a discount and I want a lot of them,'” said Achal Prabhala, coordinator of the AccessIBSA project, which campaigns for global access to medicines. “You could imagine what an amazingly tempting business proposition that is.”
Though the process faced by the U.S. and others was far from simple, COVAX had to grind its way through a far more complex web of regulatory systems and indemnity agreements on national and multilateral levels.
Aylward at the WHO recalls seeing the deals struck by rich countries and thinking, “Wow, you are paying three four times as much — these countries were desperate.”