Of the 1.3 billion COVID-19 vaccine dose donations promised to COVAX by wealthy countries, only 150 million doses have actually arrived – around 9% – Gavi CEO Dr Seth Berkley told the World Health Summit in Berlin on Monday.

Ensuring that countries delivered their promised doses “now” was COVAX’s “core ask”, said Berkley, who added that the global vaccine facility was also pushing vaccine manufacturers for greater transparency about deliveries. 

“Our perception is that delays often occur in [COVAX], whereas manufacturers provide vaccines through their bilateral mechanisms,” he added.

Germany’s Dr Lars-Hendrik Röller, Director-General for Economic and Financial Policy in the Federal Chancellery, said that it was very important that the G7 countries delivered on their dose-sharing commitments.

The G20 countries meet in Rome over the weekend, and Röller said he was heading to the city on Tuesday to start pre-meeting negotiations on both vaccine equity and climate financing.

‘Stop-start’ vaccine delivery compounds hesitancy

Ethiopia, Africa’s second-most populous country with a population of over 115 million people, has only been able to administer 4.2 million vaccines due to vaccine shortages, Health minister told the summit.

“When you get very few doses, the demand is high but it is hard to keep the momentum,” said Tadesse, adding that the stop-start supply from COVAX has compounded vaccine hesitancy.

“We initially launched with two million doses of AstraZeneca, which we rolled out but then we could get the second dose on time,” she said, adding that it was very challenging for a country as big as Ethiopia to schedule deliveries for vaccines that arrived “every now and then”.

Ethiopia aims to vaccinate 20% of its citizens by the end of the year – only half the World Health Organization’s (WHO) global target – but even that will be difficult because of delivery challenges, said Tadesse.

Thomas Cueni, Director General of the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), said that he believed COVAX was finally on the right track to deliver vaccines to all as there were “sufficient supplies”

“We will exceed 9.3 billion doses manufactured by the end of October, more than 12 billion by the end of the year and probably 24 billion next year,” said Cueni.

COVAX hopes to get one billion of these doses by the end of the year, to add to the 400 million doses it has delivered so far.

Predictability of delivery

Acknowledging Berkley’s call, Cueni agreed that manufacturers “really need to find ways and means to improve to transparency on the predictability of the deliveries”.

“Be it from COVAX contracts, or be it actually sitting down with countries willing to share doses to address all the complexities, be they logistically or be they legal, to make sure that these doses can be shipped before the shelf life expires,” said Cueni.

Other short-term priorities to get vaccines where they are needed, include optimising production, eliminating trade barriers, including on special syringes needed for the Pfizer-BioNtech vaccine, and ensuring country readiness, said Cueni.

Röller, who is also co-chair of the COVAX Vaccine Manufacturing Working Group, said that the group would table a number of proposals at the G20 meeting, based on short, medium and long-run workstreams.

Immediate priorities focused on vaccine delivery, including “swaps and more transparency in the contracts”, and less restrictive trade and custom rules in the area of trade and customs. 

“Boosters, we discussed for a long time and the working group made a pretty sensible suggestion that [they] should be based on clinical evidence,” said Röller.

“And the final one is the long run, which is the localised production,” he added. “There are several models you can think about localising production and in particular we have an mRNA hub in South Africa, which is the first one, but there’ll be others to follow,” said Röller, adding that German companies were exploring joint venture options in Senegal and Ghana.

Elhadi As Sy, Chairperson of the board of the Kofi Annan Foundation, warned of the erosion to trust caused by vaccine inequity, saying that the world was “crying out for strong leadership”.

“The data suggests that 90% of doses have gone to 10% of countries. So this says that the place where you live becomes the biggest determinant of your health status, and also determines your access to commodities, and mostly determines if you survive,” said As Sy.

“A truly global response has to be in an inclusive response. What civil organisations are feeling is that they’ve been betrayed in many ways. So many promises have been made, and so many promises have been broken without any consequences. Leaders can meet in UN General Assembly special sessions and make commitments. Very few deliver. And then so what? The consequence of that is your trust is being eroded, and there will be no inclusion, no real partnership, without trust between leaders and citizens.”