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February 2021: COVAX & Fairness in International Vaccine Distribution

By Edward Chen


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After entering the month with 440,000 deaths, the US surpassed 500,000 deaths from COVID-19 three days ago on February 23, 2021. With a population of approximately 330 million people, this is the equivalent of over 15 deaths out of every 10,000 people. This is also slightly over 20% of the 2.49 million worldwide deaths from COVID-19 recorded by the World Health Organization (WHO). The US is followed by Brazil, with slightly over 250,000 deaths, Mexico, and India.

In addition to passing half a million deaths, the US also set a near record of 5,498 deaths on February 12. This figure is behind only the 6,488 deaths on April 15, 2020, when the coronavirus was relatively new in the US. In the last one and a half weeks, the rate of new deaths has decreased somewhat. The US Centers for Disease Control and Prevention, better known as the CDC, predicts a continuing decline in both new deaths and new cases, though the prediction also puts the cumulative number of deaths in 2 weeks, on March 13, at a discomforting 530,000 deaths.

More positively, cases have followed a generally consistent decline since the middle of January. On February 12, the day with a near record 5,498 deaths, the US reported fewer than 100,000 new cases a day for the first time since early November. In total, the US has now had over 28 million cases. India, a population with over 1.2 billion people during their most recent census in 2011, comes in second with 12 million cases.

The US may be helped by its ongoing vaccination effort with vaccines manufactured by Pfizer-BioNTech and Moderna. 46 million people in the US, composing almost 14% of the population, have received at least a single COVID-19 vaccine dose. Both of the vaccines used in the US require 2 doses, so fewer than half of those vaccinated have been fully vaccinated; 21.5 million people, or 6.5% of the population, are fully vaccinated. Additionally, over 91.5 million vaccine doses have been delivered. The difference between the numbers of delivered and administered vaccine doses is partly due to recent weather conditions that have caused a delay in vaccine shipments and a backlog of vaccine doses.

As evidenced by the widespread vaccine rollout in the US, scientists have developed safe and effective vaccines that have undergone clinical trials and been approved in less than a year -- a remarkable achievement. For everyone, the approval of COVID vaccines is welcome news. However, with this step forward, there is concern that not all countries will have the ability to access these new vaccines. Smaller or developing countries have less bargaining power with manufacturers, while larger or wealthier countries, like the US and the UK, are already making deals for millions of vaccine doses that they are already distributing.

The US, with a population of 330 million, has purchased 300 million doses each from Pfizer and Moderna for a total of 600 million vaccine doses to be delivered by July 2021. The United Kingdom has secured access to 355 million vaccine doses, including a combined 140 million doses of the Oxford-AstraZeneca and the Pfizer-BioNTech vaccine, for its population of under 67 million people. This month, on February 10, the World Health Organization noted that “of the 128 million vaccine doses administered so far, more than three quarters of those vaccinations are in just 10 countries that account for 60% of global GDP.” WHO statistics also indicated that 130 countries, representing 2.5 billion people, had not yet started vaccination efforts.

Recognizing that ending the currently ongoing, and devastating, pandemic will require worldwide coordination, the WHO launched the Access to COVID-19 Tools (ACT) Accelerator in April 2020. The ACT Accelerator, referred to by the WHO as a “framework for collaboration,” is composed of 10 participating organizations. The partnerships aim to deploy and increase the availability of diagnostics, therapeutics, and vaccines for the coronavirus, as well as improve health systems worldwide, with a focus on COVID-19.

As one of the 4 pillars of the ACT Accelerator, the WHO, the Coalition for Epidemic Preparedness Innovations (CEPI), and the Global Alliance for Vaccines and Immunization (GAVI) have joined together to lead COVAX, an initiative aimed at guaranteeing “fair and equitable access” to COVID-19 vaccines for everyone in the world. COVAX aims to offer doses to at least 20% of the population in all countries, “end the acute phase of the pandemic,” and thereby rebuild economies. COVAX predicts that COVID-19 vaccines can save the economy $375 billion globally every month.

Crucially, COVAX is more than talk. Well, talks and negotiations are part of what makes COVAX promising. On December 18, 2020, COVAX announced deals for nearly 2 billion doses of vaccine candidates, of which at least 1.3 billion doses would go to 92 low- and middle-income countries. At the time, Pfizer and BioNTech had just received an emergency use authorization for their vaccine from the FDA, while Moderna’s emergency approval was widely expected. The COVAX announcement included agreements and options for 1.97 billion doses of vaccine from Oxford-AstraZeneca, Johnson & Johnson, Novavax, and Sanofi-GlaxoSmithKline.

Or, including just the vaccines which are furthest along, which are Oxford-AstraZeneca’s two-dose vaccine and Johnson & Johnson’s one-shot vaccine, the combined deals supply COVAX with a total of 1.77 billion doses. Johnson & Johnson applied for an emergency use authorization in the US on February 4. Meanwhile, Oxford-AstraZeneca’s vaccine was approved by the UK for temporary emergency use on December 30, 2020 and green-lighted by the WHO, which added the vaccine to its Emergency Use Listing, this month on February 15. Entering the listing marked a major milestone as this is a requirement before distribution through COVAX. COVAX later signed an additional agreement for up to 40 million doses of the Pfizer-BioNTech vaccine and anticipates delivery of 150 million doses of the Oxford-AstraZeneca vaccine in the first quarter of 2021. 3 days ago, on February 23, COVAX began its first wave of vaccine shipments, with 600,000 doses arriving in Accra, the capital of Ghana, a day later.

Because the SARS-CoV-2 virus, which causes COVID-19, continually mutates, new variants will inevitably arise. These variants may potentially spread more quickly or cause more deaths, as seen with the B.1.1.7 strain common in the UK, and evidence has emerged that some existing current vaccines are not as effective against certain SARS-CoV-2 variants. South Africa notably stopped administering the Oxford-AstraZeneca vaccine due to preliminary data on the B.1.351 variant prevalent there. The data suggested the Oxford-AstraZeneca vaccine did not protect against developing mild to moderate illness, though the sample size was not large enough to study severe COVID-19, hospital admissions, and deaths. While companies like Pfizer-BioNTech and Moderna continue to work on booster vaccines that better counter variants, it is still important to make sure that COVID-19 vaccines are available to anyone.

Remember: No one is protected until everyone is protected.


Results from ongoing research and the current understanding of COVID-19 are constantly evolving. This post contains information that was last updated on February 26, 2021.


Edward Chen is a master's student studying immunology. He's also the national president of Students vs. Pandemics. @EdwrdChen

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