“Building a Sailboat in a Storm”: The Evolution of COVAX in 2021 and Its Impact on Supplies to Southeast Asia’s Six Lower-Income Economies

Summary

Introduction

As it became increasingly evident that vaccines would be central to the recovery from the global pandemic, the COVID-19 Vaccines Global Access (COVAX) Facility was created to ensure equitable access to COVID-19 vaccines, especially for poorer countries. However, the erratic and delayed COVAX shipments in the first half of 2021 led to doubts about the Facility’s ability to fulfil its pledge of securing and delivering 2 billion doses by the end of the year. In June, the Malaysian vaccine minister Khairy Jamaluddin derided it as an “abysmal failure”. Remarkably, by September 2021, the Facility was confident enough to forecast the allocation of 1.4 billion doses by the end of the year—with 1.2 billion of those to be disbursed gratis to lower-income countries. COVAX’s improved fortunes in the latter part of 2021 can primarily be attributed to a surge in dose donations from wealthier countries, as they began releasing their excess inventory of vaccines.

This article will examine how the COVAX Facility evolved in 2021 over two distinct phases and the implications for six lower-income Southeast Asian countries. In the first phase, which coincided with the first half of 2021 (1H), the COVAX Facility had to rely on its own ability to purchase vaccines from the manufacturers. In the second phase, from July onwards (2H), the Facility was instead sustained by dose donations from the West.

In the first phase, the supply of COVAX shots was scarce for Cambodia, Indonesia, Laos, the Philippines, Timor-Leste and Vietnam—the six Southeast Asian countries which qualified for free COVAX shots (hereafter referred to as the AMC6). In 1H 2021, the AMC6 were promised 25 million COVAX doses, but the Facility only delivered 16 million doses, or 65.3 per cent of the AMC6’s entitlement. The shift to the second phase significantly boosted the frequency and volume of COVAX shipments to the AMC6. In 2H 2021, a total of around 128 million COVAX doses were shipped to the AMC6, with around 104 million (80.9 per cent) of these shots sourced from dose donations from wealthier countries.

However, as this paper will elaborate at the end, the Facility’s evolution into its second phase (COVAX 2.0) does not entirely align with the goal of developing a truly multilateral institution to advance vaccine equity.